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�.— APPLICATION FOR SANITATION 'PERMIT Permit No. .1_ _________________ <br /> (Complete in Duplicate) <br /> Date Issued ___ <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. 17 3-- 2-70(-D <br /> - ________JOB ADDRESS AND`L ---- <br /> A <br /> � -Owner's Name----�_ - - - Phone--------------------- <br /> Address <br /> Address---------- <br /> --------- ---- � 6 ----��-----•--------------- --- <br /> Contractor's --------------------- Phone1 !?_2 <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __-i�__ Number of bedrooms Number of baths _ Lot size ___ 3 <br /> Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table�ft. f <br /> l � � <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobIv Hardpan ❑ <br /> Previous Application Made: Yes ❑ 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.) (J� <br /> ep Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- <br /> ) Pt <br /> No. of compartments-----------------------�_Size--------------------------------Liquid depth------------ --- ---------Capacity------------------- 1 <br /> Dispbs iefd: Distance from nearest well--.7V-.--___Distance from foundation.. --0T Distance to nearest lot line------J------- 0O <br /> Number of lines---------/___- Length of each line------ -_____,_--....Width of trench.___,. ,__...__._____._ <br /> Type of filter material__ __ _ Depth of filter material ____IJF�--______-Total length-------- _ _______________ m <br /> Se a Pit: Distance to nearest well__/_Q-_10-------D•:stance rom founclation__x`0-._--__.Distance to nearest lot line__ --------- <br /> "R -- <br /> _--- ' <br /> Number of pits-----,------------Lining material_ _ _.__. _.Size: Diameter---- _.Depth_ .__--_-- <br /> Cesspool: Distance from nearest well-----------------Distance from 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 /> ----------- ---------------------- <br /> Remodeling and/or repairing (describe _ • "� - -_.�-- - ----------- r--------------- <br /> -� <br /> ----------- <br /> _ <br /> ' T ---------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------- f% <br /> I hereby certify t I have prepar i pplication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State s and es an regula • ns of the San Joaqu. ocai Health District. <br /> (Signed) --r-�V�r ----------- - '-- Owner and/or Contractor) <br /> By:------------------------ -•--•-------------- ---- - ----- ----- <br /> - i le)---.- --- -- <br /> (Plot plan, showing size of lot, location of system in rel • to w�els,buildings, etc., a be place on reverse sidel. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------�---= ^s -- ---------- ------------------------------------------------ DATE-----6- $-- �-k---------------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------ --------------------------------------------- DATE---•--------------------------- •---• --- ----------------- <br /> BUILDINGPERMIT ISSUED--------------•------------------------------------------------------------•------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-------------------------------------------------------------------------------------------------- ------------------------------------------------------------ <br /> ----------------------------•-------------------------------------------------------------------------------------------------------------------------•---------------•--------------------------------------------•---------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ­ <br /> ------------------------- <br /> - -------------------------------------------------- ---------•----------------------------------------------------------- ------------------------------------------------------------------- ------------------- ------ <br /> FINAL INSPECTION BY:- .�a------------------------------- Date_._.G- -..c--"---fo -�---------- ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 6-'59 F.P.Co. <br />