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µ R-OFFICE USE: ' <br /> I <br /> ------------- ------------------- A <br /> I ��) <br /> APPLICATION FOR SANITATION PERMIT Permit;;No. ... ....:. :....... <br /> ------------- ---------------••--- (Complete in Duplicate)' ��• `3 <br /> ,� Date issued .... .. _-_--•--• <br />-------------------_.______..._..----..._._____--_.___ This Permit Expires <br /> l 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 /> JOBADDRESS AND CATION - - -..- --•-••---- -------- -------•-••--------=------------------•-•---------------------------------�... / + <br /> Owners Name ------- ...--•- ---------•----- :_:._._ Phone e y <br /> .-- .--• . <br /> Address. ---••• .......... --•--------•-- r -------_1..........--------------------------------------------- -----•-----.... -----------------------------•--------.� <br /> f > <br /> Contractors Name_::_.. <br /> ..----------•-- •---------------- ---------------------- <br /> '. Phon.if <br /> e.. - - r <br /> Installation will serve: Residence &J!Apartment House ❑ Commercial ❑ Trailer 'Court ❑ Iwotel'.❑ Other ❑ �r <br /> _____.-Number of baths ___r___ Lot size ..1=tl �. <br /> Number of living units: ..-1____ Number of bedrooms • •---ti=----•••------••-•------•--•----••-•- <br /> Water Supply: Public system Communi+y system 0 _Private ❑ Depth to Water Table t. <br /> Character of soil to a depth of 3 feet: Sand ❑ .-Gravel 10 1 Sandy Loam ❑ Clay Loam ❑ Clay 0 Ad&be 5Hardpan 0 <br /> Previous Application Made: (if yes,date...._---------------j: No New Construction: Yes 09,,-No ❑ FHA/VA: Yes ❑ No Pl`—`- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi c4,,Tank: Distance from nearest well__Y�Q,..Distan a from foundation.-. <br /> � _ M e jai----�'-'='-='-`--`'�"�'-�.=�.t <br /> I <br /> ------------ <br /> -Li uid de th �Y Ce aci , �� � <br /> No. of compartments-----�---------------Size----- ... Liquid P. P tYJ <br /> Distosl Fields Distance from nearest well------------------Distance.from foundation---------------.....Distance to nearest lot lin`�e................. . <br /> Number of lines --------------------------------Length of each line..------•------------- Width of trench � <br /> Type of filter material------------------------`Depth ofYfilter material-----------------------Total length.....-..-----••------------%............... <br /> � R <br /> Seepage Pit: Distance to nearest well____________________Distance from foundation_.....______.__.__..Distance to nearest lot line... ----------- <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_----------:------. -:Depth--.---------------.._ - I. <br /> k� Cesspobl: Distance from nearest well-----------------Distance from foundation---:----------------Lining material--------------------------------------- <br /> ❑ Size: Diameter--------------------------------------Depth------------------;.----------- Liquid Capaeity gals. <br /> Privy: Distance from nearest well-__________------------------------------ -----Distance from nearest building-------------------------------- <br /> ❑ Distance to nearest lot line------- ---------------------------- ---------- ---------------­-------------------------------------------------------------------------- -`• <br /> ;Rem dehng d/o repair g (describe)::,-------- --- ----- --- - ---- ----------------------•----------------------- � <br /> _jN <br /> -----------------••--------------------------------------------•-•-----------------------°-•---------------•-------------••------------------------•-•--------------------------------•----..-------------------------------- r <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 /> r <br /> .� - -------•--------- ---------------------------------------------------------------------......... (Owner and/or Contractor) <br /> BY= n -• --------------- -- ---- ------------------------------------•-------------=----------(Title} i r <br /> �, <br /> Im (Plop plan, showing size of location of system in relation to wells, buildings, etc., can be placed�on reverse sided <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------ ------•---- DATE------------ ` � --•-•----•---- <br /> REVIEWED BY-------------------------------------------- = ._.... DATE. <br /> ' BUILDING PERMIT ISSUED-------------------- -------- ......-- ---- •----------------- - D,4T�_= � � <br /> .�--- — -r' ��.-�'`--P.`------ L�` -0-- -� �------------------•- <br /> Alterations and/or recomme+n'd'ations:-----------------------f------:---.-..-. .------•-------•••--- •- ------------------------------------ <br /> i -z-c....Z, _ "��.`....._... -.-•-------••- <br /> `- -k2--�C-r-t . �•-=x ��cam------ <br /> ----------------- <br /> c <br /> -- -p -! "`------- _,� ----------- .... -=x L -ems-- <br /> _/ ------���---_P--L C!!!JJ^F Rrt•—G <br /> a ! � ----------------------------------- <br /> `FINAL <br /> C'1 = �---`"c-=c'-- m-C__-�-�---------------- <br /> [y -- ---------­-- - -------J --- •--------1 -------------- ---- e-L�f? -' <br /> FINAL INSPECTION BY:------- Date-------- d - <br /> * S JOAQUIN LOCAL HEALTH DISTRICT <br /> F <br /> 13.0 South American Street 300 Wast Oak Strati" 124 Sycamore Street 205 Wast 9Th Stroot <br /> Stockton,California Lodi,California Manteca,California Yracyr California <br /> l ?' q <br /> ES 9 REViSEa 8-99 YM 5-61 ATLAS =#' - <br />