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•---FOR IFICE Lr5E. <br /> ------4,0 <br /> ........... . ... <br /> --------- --------------- APPLICATION FOR SANITATION PERMIT Permit N0. 2- <br /> -------------------------------------- ------------------ (Complete in Duplicate) <br /> --------- -- ---------------------------------- i This Permit Expires 1 Year From Date Issued Date Issued ........ ............ <br /> Application is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in cornpliant`e with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-------------- --- <br /> Owner' <br /> s Name.-•-------- ------------- - . ....... -------- ------------------------------------------........... Phon <br /> Address----............3-. : <br /> .. ....... <br /> ... . ....t__,...................................................................................... <br /> Contractor's Name............. ---------------------------------------------------------------............................ Phone............................ <br /> Installation will serve: Residence Apartment House 0 Commercial E] Trailer Court'E] Motel [I Other [3 <br /> --ny,A/ .7, ap _-�- <br /> Number of living units: Number of bedrooms _;,L Number of baths .-//- Lot size I...... .................................. <br /> Water Supply: Public system rUl Community system [3 Private F1 Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam C] Clay Loam* Clay [] Adobe'[ ' Hardpan ❑ <br /> Previous Application Made: (If yes,date-------- -----------I No Yeses Construction: YesNo [] FHA/VA: Ye" [:]s No <br /> TYPE OF INSTALLATION AND SPECI.PIC.ATIONS; y <br /> (No septic tank or cesspool permitted if pubwithin_sewer is available 200 feet.) <br /> Septic Tank. Distance from nearest well-- .....Distance from foundation-------A . <br /> ?.....Material................................................. <br /> _E1 No. of compartments----------- -------------Size---_------------------------I...Liquid ..........._.............Capacity................. . <br /> D' I Field: Distance from nearest well-_4",ol....Distance from foundation.....Z-0........Distance to nearest lot line.-­ <br /> Number of lines---------------- /-------- <br /> Length of each line----- Width of,trench_-----------k.9... <br /> length... 3-- �._. _ <br /> of filter material....... ------Depth of filter material_______ <br /> S6 e Pit: Distance to nearest,well-----/6------__.Dista dation__--- Distance to nearest lot line..._... <br /> r <br /> Number"of pits-------j Lining material... 'Size: Diameter.------)�_7.........Depth------------------------ ------- <br /> .... ...... <br /> Cesspool: Distance from nearest well________________ bis 'nce from nclation--------------------Lining material------------------------------------- <br /> ❑ <br /> ...................................... <br /> Size: Diameter----------------------- --------------Depth_ ..Liquid Capacity,---------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building__-_________--..-______-.-_..__.________. <br /> Distance to nearest tot line-------------- - <br /> Remodeling <br /> ine--------------- <br /> Remodeling and/or repairing (describe):-------- -------- -------------------------------------------------------------------------------------------------------------:...... <br /> ............................... -----------------_-------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----­---­--------------- -------------------------------------------------------------------------------------------------------------------------------—------------------------­­----------------------------- <br /> -------------- ------------------------------............I--------------------------------------------------------­--­flk----------------------------------------------------------------_------------------------ <br /> I ihereby 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 ulanficins Of the San Joaquin Local Health District. <br /> (Signed) <br /> ----------�: ----------------------- - -------------------------------------------------------------------------------------------__.__(Owner 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 /> FOR)?EPARTMENT USE ONLY <br /> f <br /> APPLICATION ACCEPTED BY------ --- -11------ ------- ---------------------------------------- DATE-- �"' <br /> REVIEWED <br /> ATE--- <br /> REVIEWEDBY-------------------------------------------- -------------------------------------------------------_-----------------_ DATE -------------------- <br /> ---------------------------------------------- <br /> BUILDINGPERMIT ISSUED. ------------ --....... ----------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recornmenctafioni;0 ----- ­- -------------------- j-----------111.1--------------_------ <br /> --------------......... ----------------------- -------------- ---------------­---------------------------- --------------------------I..........I--------------- ----------------­.Y ----- -- -- - <br /> - --------------- <br /> ...........­­-------------------------------------------------:........ ----------------------------------------------------------------------------------------------------------------------------- ------------- <br /> ---------- ..................... ---------------------------------- - --- ---------------------------- ------------------------------------------------------------------------------- -------..................... <br /> FINAL INSPECTION BY:....... ---------- --- <br /> 'j---------------- ------ ----------------------------...... ............----------------- <br /> )SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street # 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Locil,California Manteca,California Tracy,California <br /> E6 9 REVISED 8,59 OM 5-6t ATLAS <br />