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FOR OFFICE USE: <br /> _--- APPLICATION FOR SANITATION PERMIT Permit No. _ �__3 � <br /> - <br /> ------------------------ -- ----- --------- (Complete-in Duplicate) <br /> ........................ _ _- ____. _ .._.__. This Permit Expires 1 Year From Date Issued " Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh 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 AND LOCATION___,,_-�-------- ------;t------- --------- -------------------- -------------------------------------------------------------------------------------------- <br /> Owner's Name-- ----------------------- -----•---------- --------- - ------ ------------ ------------- Phone------------•----------------------- <br /> Address.... �jc_ ------ •------------ ---------------- <br /> Contractor's Name----�d---------- =5------- ----- Phone------ -_-------_-_----------- <br /> Installation will serve: Residence []`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __!----- Number of bedrooms -.'2- Number of baths I_____ Lot size _d_:C?.X ` <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _40ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel p Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[9--Hardpan ❑ <br /> Previous Application Made: (If yes,date___________________ I No [ New Construction: Yes ❑ No F!r�FHA/VA: Yes ❑ No E � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic nk. Distance from nearest well_________________Distance from foundation--------------------Material ........---------------------------------------- <br /> M� No. of compartments------------------------.Size.----•----------- - -- -----•---Liquid depth--------- ----- --------Capacity <br />` Disposal i Id: Distance from nearest wefl--________ Distance from foundation--------------------Distance to nearest lot line------------_-... <br /> ❑ Number of lines ----------------------------------Length of each line------.---------------------- Width of french----------------------------------- <br /> 41cType of filter material-------------------------Depth of'filter material_._.___.___._.-.___._Total length-------.------_________-----.------------- <br /> Pit: Distance to nearest well.-----_ ___-...-_.Distance..from foundation/ff--------------Distance to nearest lot iine_�r--------- <br /> [ Number of pits.__ ._j______________Lining material' [-�C_-.- Size: Diameter-t.X---------Depth_..-_j�.__�______-_-..------ <br /> Cesspool: Distance from nearest well ________________Distance from foundation_-_ ------- -..Lining material-_._._.-----___--_--__-_____------._- <br /> ❑ Size: Diamefier- - ------------- ----- ---.Depth---------E---- ------------------------------------Liquid Capacity -------------------- ----gals. <br /> Privy: Distance from nearest well----------------------------_.......f.- ___;.-_Distance from nearest building:--------_--------_-_-____-___---____--. <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe):--- - --------------- ------- ------------------`------------------------- -----• F <br /> I <br /> -------------------------------- ----------------------- -------------------•----------------------------------------------------------------- ----------- -- --------- ------- <br /> ---------------------------------------------------------------•------ <br /> __________ -------------_------------_-------------------_----------_____-_------------------------------------------------------------------------------------___ -_-_-_-_--___-_______________-____---____-.- Y <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> I <br /> ordinances, State laws, nd rules and regulatio s of the San Joaquin Local Health District. <br /> (Signed)------------------ -------- ------ -------------------- f ---------------------------- ; (Owner and/or Contractor) <br /> By:-------------------------------- -------------------- --------=----------------------- -----(Title)------ --- - --- -------------------------- <br /> (Plot <br /> -(Plot plan, showing size of lot, location of,system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLYI <br /> APPLICATION ACCEPTED BY - 1 - ; u °- DATE-- -- ----------- <br /> REVIEWEDBY----------------------------------- .--- --------------------------- -------------- ---------------------------- DATE---- ------------------------------------------------------- <br /> BUILDING PERMIT ISSUED--------- -------- ------ DATE----------------------------- ----------------------------- <br /> Alterations and/or recommendations------------------.------- - - -------- - --- ------------- ------------------------------------•-------------------------------------------- <br /> -------•---------------------------- ------------------------•-------- -- ---------------------------------------- - - ...........-- --------------•- ------- ----- ------------ ----------------•----------- <br /> ---------- <br /> FINAL INSPECTION BY:-._-__. __.--"-.___.. _ _. /--� —6'o, -. _ <br /> ------------- Date-------- ---- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha=elton 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 />