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FOR OFFICE USE: <br /> •o <br /> --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .../.................. <br /> ------------------ --------------- (Complete in Duplicate) (� c( , <br />----------------------q-2." Date Issued ---------------------• Y <br /> ---- --- - - - -- <br /> This Permit Ex ires 1 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, l <br /> JOB ADDRESS AND LQC TION-----__---• -------- 3 •---- -�- -- --• �c�.(rC..L4_Ifl _. ..... .s <br /> Owner's Name------ Ile <br /> - <br /> _ f ----------------------------------------------------------------------- <br /> iAddress__. i <br /> 4 .-1 -- r ti. <br /> - -----•------•-----------------• <br /> IContractor's Name------------------ ---------------------------------------------- <br /> ❑ Trailer Court E] Motel ❑ Other 0 <br /> Number of living units: ...t--- Number of bedrooms Number of baths .1-__ Lot size ---------4-r S-5:--------ac,.,�........... <br /> Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table _5;�.4t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandys\Loam ❑ Clay Loam ❑ Clay.❑ fAdobeX Hardpan ❑ <br /> Previous Application Made: {If yes,date--------------------) Noj � 1New Construction: Yes ❑ . No [j FHA/VA: Yes ❑ No" <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: >. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,•/1,tiC_ <br /> Sep is Tank: Distance from nearest well.._��- Distance from foundation__________________':Mater <br /> No. of compartments------------ y Ize---------------•------------"---Liquid dept----- Z---------------Capacity.................... . <br /> Disposa field: Distance from nearest well....U`n�_----Distance from foundation__ ��.__ Distance to nearest lot lin ._..__.. -- `— <br /> Number of lines----------- (---__--__-_ <br /> --_. Length of each line_______ ` d_& .�-.Width of trench..........4_ <br /> Type of filter material. e„ t/ <br /> -. Depth.of filter materiai_____..__ length------------ _.�_,�- --------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-----Z-----_.......Distance to nearest lot line__-------------,_ <br /> ❑ Number of pits----------------------Lining material---------------,---_---Size: Diameter-------,-••------.-.._.:Depth------:-------..----.-----:------ <br /> 7» <br /> Cesspool: Distance from nearest well-----------------Distance,from foundation- material...ti____.....________......__ <br /> ---•- <br /> ❑ Size: Diameter. Depth----•--------•---- -----�•-----------------------Liquid,Capacity ----------_gals. <br /> Privy: Distance from nearest well__-'`___'-'- '-._:`__1______ ______________''Distance from nearest building------------.________-_--_-________.__---- <br /> ❑ Distance to nearest lot line---------------------------------- ----------- <br /> Remodeling and/or repairing (describe):-{-----------------------------------------------•_-- 1 <br /> ---------- <br /> •--•----------•-----•----•-•-•------------------------------------•--------•-------------------------------------------------d I <br /> a <br /> -j----------------------•----------------------••----•• •----._-------•-------_ <br /> --------------______---------------------------------------------------------- <br /> l <br /> ___________________________------------------------------------------------------------_--------------- <br /> ---------------------------------------------------------------------_--------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (SignSi --•--- ---.. .. y <br /> ed)}--- ,.:- -- • - -----------------------------•----------••--------• ----------------•------------•---------------(Owner and/or Contractor) <br /> By: ••-••- ............. --•-••-•---------------------------------------------------.-------------(Title)-------- ------------- ---- •----------- ---- - -- <br /> ------------- ,- <br /> - - - <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 ONLY <br /> APPLICATION ACCEPTED BY---------- <br /> --. ___ ------------------------------ DATE_____ _____ ___ I <br /> REVIEWEDBY-------------------------------------------------------- ------ ---------------------------_­ DATE------ .----- - ------------------•- <br /> ` <br /> UIDING PERMIT ISSUED-------------------------------------------------------------—......-------------------------------- DATE--- •-----------..- <br /> A erations and/or recommendations:. <br /> -••----------------------------• --------------------------------------------------------------------------•--------------------_. ----•---------------•--•-• <br /> ----------------- --------------------- <br /> FINAL INSPECTION BY:�'►1{. .I�. -: Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lod],California Manteca,California Tracy,California <br /> ES 9 REVISED S-59 YM 5-61 ATLAS -r _ <br />