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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> - ---- ----- ---- --------- ------ - --- ------------ (Complete in Duplicate) Date Issued .�_.��..�5- <br /> ___._.__.______________________..__-_ ._____-.- --- This Permit Expires 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. <br /> JOB ADDRESS AND LOCATION-------- ----------S------------6--lJ-1 l'-RC S :UL ' <br /> Owner's Name !Ah' .an= - ---_� . _ Phone-..'f -•----- <br /> Address-----------_-------------- _„ )------------ -------------------------------------------------------------------------------------- <br /> - ---- ------------------------------------ <br /> Contractor's Name------------ = k= ti k--------------- ---------------------------------------------- Phone--................................ <br /> � <br /> Installation will serve: Residence (�` Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __(-_-- Number of bedrooms __ Number of baths ---I---- Lot size ----- -_--_---------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobejZ Hardpan ❑ <br /> Previous Application Made: (If yes date_._____ ------__ ) No New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ NoM <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tan Distance from nearest well_________________Distance from foundation--------------------Material.-_-..--_._--_-_.___-_----.-____---____-__--_-__. <br /> ❑ No. of compartments------•----------------Size-------------------------------Liquid depth------ -----------------.-Capacity----------•------•---- <br /> Disposal Field: Distance from nearest well--Yu _*_�---Distance from foundation------ '___-Distance to nearest lot line___ __________ <br /> Number of lines-----------)--------------- -------Length of each line------------1_J-__'_--------Width of trench----------�_'f_y-_____________ <br /> Type of filter materia;__S_ __1�CQ: __Depth of filter material_-._.__-X.g$..____._Total length----------------------------.`a-_�_____.- <br /> Seepage Pit: Distance to nearest well_: '�:: �< _____Distance from foundation-_-____\_L_I _._.Distance to nearest lot line___-=__P------ <br /> tKc,_Ak Number of pits-------I----------_..Lining mate ria l_S-,_i a, _� ��_ Size: Diameter---------3,3...____._Depth_____________�------------------ <br /> Cesspool: Distance from nearest well-----------_-----Distance from foundation------ ._.------ _.Lining material____.__.____--_____--._---____-_. <br /> r <br /> ❑ Size: Diameter- -- -------------- -------- -------Depth--------------- -------------------- ----------- Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well------------...--------------------------- _--__Distance from nearest building----- _-.-------------------------------- t <br /> ❑ Distance to nearest lot line----- ------- --------------------------- ------------------------------------------------------- ---------------------------------------- <br /> Remodeling and/or repairing (describe):------ ---I---------------------------------------------------- <br /> ' <br /> - - - - <br /> 1 <br /> --------------------------------------------------------------------------------------------------- 6 <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---------------- �-' - - - (Owner and/or Contractor) <br /> t- <br /> •-_--------------- `=----•=-•-- ------------- -"--- ��- ------------------------------------ Title------ ------------ ------------------------- -- ------- <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-------L��---------------------------------------------------------------------------- DATE------a-•-/�-- ' <br /> REVIEWEDBY------------------------------ --------- - ---- ----------------- ------------------- ----- ------ DATE-------- --------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------- ----------------------------------------------------------------------------- DATE------------------------------ ------ ----------------------- <br /> Alterations and/or recommend ti ns:._______._. ........----- ------------------------------ <br /> ....____..__,__._._ <br /> ---- --------- -------------- -------- <br /> ­----------- _Z : ------ c r -----�`i.-' �- __t------ ---------------------- ------------------ <br /> -------•-------------------------------------- ------------ ------------- -------- -------------------------------------------------------------------------•--- ---------------------_--------------------------------- <br /> -------------------------------- ----------- ------ ----- <br /> FINAL INSPECTION BY:----- - -----------------------------I------ - Date----- . ----------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CC. • <br />