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FOR OFFICE USE: aI <br /> A <br />---------------------------------- ---------------------- 6- W I <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br />------------------ <br /> - <br /> (CompleteinDuplicate) Date Issued <br />-------- ----- <br /> This Permit Expires I Year From Date Issued <br /> ,Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN L CATION- <br /> � <br /> ---- -------- ----- - - -------- -- -- ------------- ----- -- ----- <br /> �d-X-- -- - - - -- - -- - -- ----- - -- ------------ <br /> Owners Name_ ..... ........ <br /> - ; ------- Ph_o-n--e--.-.-.-.-.-.-..--.-.-.-..-.--.-.-.-.-.-..--.-.-.-.-.-.-.-.-.-..--..--.- <br /> . <br /> Address. .................... ..........I--- - ------ -------- ---- ... -- ------- - <br /> Contractor's <br /> Name------ --- ---------- -------- ------------------------------------------ Phone------------------------•--------- <br /> Installation will serve: Residence/[Apartment House F1 Commercial E] Trailer C <br /> ourt [] Motel E] Other ❑ <br /> Number of living units: Number of bedrooms Number of'baths ----?._Lot size ----- --------------- <br /> Water Supply: Public system E] Community system El Private T-1Depth to Water Table ------- ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam E] Clay Loam [] Clay [] Adobe [:] Hardpan 01_� <br /> Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes E] No 0 FHA/VA: Yes El No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-------------_-_Distance from foundation_-._-.-__--.----.-Material ----------------- ------------------------ <br /> El No. of compartments-.------•----------------Size------------------- -----------Liquid depth--------- ---- -- ------- Capacity------ ---------------- <br /> DisposalI <br /> 461: Distance from nearest well--....4G'."Distance from foundation-----ZdP--------Distance to nearest lot line..-5........ <br /> 211-11 Number of lines--------------/-----------------Length of each line-- -------7_,P_."f--------Width of trench--__3 ------------- <br /> Type of filter material--------5-J?-------Depth of filter maferial_.__._/.%___'­_._TotaI length---- -----7-r----------------------- <br /> See t: Distance to nearest well_-.-_/0-0_1__Distance from foundation...., _41..!__.Distance to nearest lot line-.:...._-..__... <br /> .............. <br /> el Number of pits-----/------------.L_in_i_n__g, __maferiaI------..S_/Z__ Size: Diameter--- Depth----;?��X------------------ <br /> Cesspool: Distance from nearest well -------------_Distance from foundation----_----------.- -.Lining material--__--------.----.---__---.-_--__---_ V�` <br /> ❑ <br /> aterial------------------------------------- <br /> 171 Size: Diameter- -- -------------- -......--------Depth--------------------------------------------....Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well------------__----------------------------- --Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line ----------- -----------------•----------------------------•-------------- ------------_-------------------------------------------- <br /> Remodeling and/or repairing (describe):------ =-----------•-•------------------------------------------------------ <br /> - ------------------------ <br /> c. <br /> ..........................•-----­-----------------------------_1----------- ----------------­---- - ------ -----1`--------- --------I------------- ------ <br /> -------------------------------------- <br /> --------------------------------------------­----------­-------------------------------------------------------------------------------------- --------- <br /> ----------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------............ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta i9l aws, and rules and re 411ations of the San Joaquin Local Health District. <br /> 'o S T <br /> V <br /> (Signed)- ------ <br /> D--------- --- --- ----- ----- ------------------------------------------------------------------------------------4Q4rrmTand/or Contractor) <br /> By-- -------------------------------------------- ------- --- ----- --- ------er,—------- -------------------------(Title)--- ------ ------ ------- ------------------- ------- --------- <br /> f ti <br /> s ng size of lot, location of sys ern in relati to Wells, buildings, etc., can be placed on reverse side). <br /> (Plot plan,C <br /> s <br /> FOR DEPARTMENT USE ONLY <br /> ------------------------------------------- DATE---- <br /> APPLICATION ACCEPTED BY--.Z �. _ <br /> REVIEWEDBY-------- ------------ ------_-------_--- -------------- -----------------___-------------------------------- DATE----------------------- ------------------------------------ <br /> BUILDING PERMIT ISSUED-------- -- - -------------------------------------__------------------------------ ----- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:----------------- -- ----- -------_---- -------------------------------------------------------------------------------------------------------------------- <br /> ------------- ------------------­-------- .......... ---------------------------------------------------------- ----­------------- ---------------------------------------------------------I-------------------------- <br /> ----------------- -----------------­------------------------------ ------------------------------------------------------------------- -------------------------------------------------------------------------I---------- <br /> ................. ------------------ ­----------­---- •-•------------...---------- ------------------------------­------------------------ ----------- -------------------------- ------•---------- ------•--------------- ------ ------------------ ---•--------...-------------------------------- ------------------ -----------------­­---------------------------------------- ------_----- <br /> FINAL INSPECTION BY:.� ----- ------- --------- ------ --------------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />