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/ F R OFFICE USE: <br /> �--------- <br /> "APPLICATION FOR SANITATION PERMIT Permit No. .�'.. �. � <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 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 CATION.s ® --- - --�------------------ --- - <br /> Owner's Na . --- ----- 4= ------------ Phone <br /> Address.--------- -•------------------ --- Ql 1------------ �// <br /> Nam <br /> ..- r_(--- -- ---- -- ----- - ---- -mac_. _-..__ Phone.TV- <br /> Contractor's -- ��;?5/--- <br /> Installation will serve: Residence Apartment House Commercial Trailer Court ❑ Motel ❑ Other <br /> s <br /> Number of living units: ._I--_-- Number of bedrooms _. -- . Number of baths__�_.__ Lot size __-7, _----X-_/_��-1------------------ <br /> Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table Ar ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe� Hardpan ❑ <br /> Previous Application Made: (If yes,date---------------- No ❑ New Construction: Yes ❑ No, 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.) <br /> i Qt Distance from nearest well.............. ..Distance from foundation_.._-.-__----..__..Material -------.___.----------------------..._.-:--_-__. <br /> No. of compartments-__-- ..... <br /> - -------- --Size------------------_ -----------Liquid depth--------- ----- --- Capacity---------�- <br /> Di dal Distance from nearest well ... ...........Distance from foundation._ O.......Distance to nearest lot lin .___._ <br /> Number of lines--- . _.- _--_Length of each line--_Z747. ............Width of trench-----��_�`1/`__...f.. s <br /> Type of filter materi Depth of filter material----- _-__------Total length____________________________�___ ______ <br /> Seepage Pit: Distance to nearest well-------------- -------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Number Number of pits______________-._._.L' ing material:--.-_._.-.-_---._'. Size: Diameter_-__--.-_----.-__.-.__.Depth_:.._..__.._________...._____.__. <br /> Cesspool: Distance from nearest well .............__Distance�frorn foundation_- _.-__--_ -.Lining material_.... .--._.___--.:___-___---. <br /> ❑ 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 /> -------------------------------------------------------------------- ------------------------------------------------------------------------------ ----------------------------------------------------------------- <br /> 1 hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St I 4s, and rules an egulations of the S Joa in Local Health Di trict. <br /> a <br /> (Signe - ------t-------_-- <br /> Contractor) <br /> By:-_- -----------(Title)-------- --- ------_------- - --- ------ --------- <br /> (Plot plan, showing size of lot, location of system in relatio we Is, buildings tc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------- --- ------------------------------------------------------ -------------- DATE-------- ------------------------- <br /> REVIEWED BY------------------------- --------- ---- ------ DATE----- <br /> --- ------------- --------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------- DATE---------------------------------- ---------- <br /> Alterations and/or recommendations:_----------------------- ---------------- ------ --------------------------------------•------------------------------------------------------------------- <br /> ------------ -------- -------------- -------------------- ----------- ------------------------- ----------- <br /> 1 <br /> --------------- ------------ ------ ----------------------- ----------- ---------------------------------...---- ---------------- --------- <br /> --- - -- ------------- -- --- <br /> - <br /> ----------- - `r'-�`-------------------------------•---------- ------------- -------- ---------- ------------ ---- --------------------------- <br /> FINAL INSPECTION ..........................................------- Date..... <br /> .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1301 E.Hazelton 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 />