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APPLICATION FOR SANITATION PERMIT Permit No. 2— <br /> (Complete in Duplicate) <br /> This Permit Ex ires 1 Year From Date Issued Date Issue ��-���O <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descri e . <br /> This application is made in compliance with County Ordinance No. 549.r <br /> JOB ADDRESS AND L I ------------------- <br /> Owner's Nf( t <br /> -------- - - ,f <br /> Address-----ame------ -------- ---4----•- - ----------------------------------------------iPhone <br /> Contractor's Name------------------------- Phone-------_-_--- <br /> •-------• ------ <br /> Installation will serve: Residence M Apartment House-'L] Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ 4 <br /> is-'v t .3 l <br /> Number of living units: _�____- Number of bedrooms -------- Number of baths --_-.-'Lot!size -----..?---�-.�--'� <br /> s <br /> Water Supply: Public system a Community system 0 Private ❑ Depth to Water Table . <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ;Clay ❑ Adobe4N[�_Hardpan ❑ i <br /> Previous Application Made: Yes ❑ No K New Construction: Yes K_No L] FHA%VA: des E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ! ` J <br /> 3 � t <br /> Se tic.Tank: ,Distance from nearest well__ !-"_V±�Distance from foundation_--_/Q-r <br /> (No septic tank or cesspool permitted if publi sewer is available within 200 feet, <br /> p - ------.Mator1al-------------- - - �-.- ' <br /> No-of compartments- - __- _- `aSize=-: <br /> ;!s✓s -- Liquid depth_---4- -------------Capacity---- <br /> P rye ��y <br /> Disposal Field: Distance from nearest ell-__-.-.--= .Distance from`foundation--------------------Distance to nearest lot <br /> Number of lines----_- `__ __ _______ ---! Length of each line--------��f_ -----.Width of trench- r <br /> — - ------------------- t <br /> tt�l <br /> Type of filter ma ale_-------__- ''._-'Depth of filter material--__----A�-_____--Total length--- _ � _--_---__--- <br /> Seepage Pit: Distance to nearest well_----------=----------Distance from foundation-------------­---- to nearest lot line--_-___-----•. J I <br /> ❑ Number of pits_`-_-_--__?_t.-4-';Lining material_______________________Size: Diameter------------------ <br /> -----Depth-------------------------------- V , <br /> Cesspool: Distance from nearest weJ1-----------------Distance from foundation------------------- Lining material---.-__.-._--------_-----_" _:'___- �7, <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 /> --------------------------- <br /> CA <br /> Remodeling and/or repairing (describe):-------------------------------------------------------....------------------------------------------ <br /> ------------------------------------------------------------------------------------------ <br /> ------------- <br /> --- --------------------•---------•----------- -------------••------------------------------------ <br /> x 1 <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 LoU Health District. # <br /> (Signed -:Z, --� ._-- <br /> - ------ ---------------------------------------------------------------- -4�and/or Contractor) <br /> By:------/-- <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 /> 4 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -----t `------------ ---------- DATE-----------�- - <br /> --------- --------------------------- <br /> -REVIEWED BY------- =`- y----- -----------` � - '- DATE--- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------- ------------ <br /> - i <br /> Alterations and/or recosrynendationsi--------------- ------------- <br /> ------`------------------ f - 1r��'r---t- - <br /> ------ --------------- <br /> --------------------------•--------•---------- <br /> ---------- ---- <br /> -- - --- <br /> '1 z 1-116 ! <br /> FINAL INSPECTION BY------- ------------•-------------------- Date- <br /> -------------------= <br /> ,x- 0' <br /> ( � _L_ SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 614 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2hn Revised 8-'59 F.P.Co. <br />