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FOROFFICE.USE: <br /> -- M APPLICATION FOR SANITATION PERMIT Permit No. ..'___ <br /> ------- -------_`----------- (Complete in Duplicate) �-1 Z <br /> R- --------- ----------------------- -gip' This Permit Expires 1 Year From Date Issued Date issued L._!_�..._.. <br />- <br /> ---------- -- - - <br /> Application is hereby made to the San Joaquin Local Healfh Qistrict forma 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 �1 ------ ----------------------------------- <br /> Owner's Name .I"&-----! .____ J-------------------------------------------- ........... ------_---------------- Phone...------'=-------............... d <br /> Address......--•--•• r :.................... <br /> = f . <br /> Contractors Name.. ,.? I --- -- -----------'_ 1f .✓..-.�� l- r� _ti.. . .......................... Phone..- ---. ........... <br /> Installation will serve: Residence ©I-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:'i:._il.... Number of bedrooms,.___P—I.Number of baths ____I__ Lot size ..._. .7 .__.. _._.�` i ____________________ <br /> Water Supply: Public sysiern' ❑"'Community system ❑ + Private Depth to Water. Table `?: ft. <br /> Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑'� Clay,❑—Adobe Hardpan ❑ <br /> — <br /> Previous Application Made: (If yes,date---------- --------I No ED ew Construction: Yes [E3'No E] FHA/VA: Yes [I No ❑� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1 Septic lank: Distance from nearest well-----------------.Distance fromfounLation....................Material................................................. <br /> FRJdJ <br /> No. of compartments----------------.---..__-_Size-------•-------------`-----,_--Liquid depth------------ --------_._- Capacity---_.._.__....I....._.. <br /> Disposal 4Disfance'from nearest-well--_--_----.-Distance from foundation----Z� `�� <br /> __..._._..Distance to nearest lot line................. <br /> ILI <br /> { Number ones_____________ Length of each line______,__ c__. ....... width of ......_.._.._._:_ trench '' _�� <br /> r bf line's j 9 ff �+..1 'q <br /> Type of filter e�Aaterial..._10�e�__.___Depth of filter material ...1_� _..........Total length_ .3-__--•_--_________f_{_-- <br /> Seepage Pit: Distance to nearest well____..�i � Distance from foundation....�.�.......-..Distance to nearest lot !ice �_______._ ! <br /> t i --- <br /> .� e _ <br /> Number of pits.....i---------------Lming material_____�•: __ ____.Size: Diameter---.___ ___.________Depth------ <br /> Cesspool: <br /> __._-Cesspool: Distance from nearest well------------_____Distance from foundation___._-_______`____.Lining material----------------------............... <br /> Size: Diameter---------------------- -------De th-----------------------------------------------------Li uid Ca aci r <br /> El .i --------- pq � p tY------•-----------•----•----gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------------- <br /> ❑ Distance to nearest lot line-----------_---- -----------------------------------------------­-1.}-•----------------•-------••--------------------------------------- <br /> ------------ <br /> Remodeling and/or repairing t-describe}:---------� I -________ -t�'U — - ?-__----Y _.____ � ►s :_•- <br /> - <br /> --------------•----•---------------..........-....1�- ••--=--•--•----•---•----------------- ---••--------•--------------------------•-----------------------------------------j----------------- <br /> ­ <br /> i <br /> II <br /> �I - 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: I <br /> (Signe t�, ------------------------------------- -----.Owner and/or Contractor <br /> By:-----� �1M. ....•--• a <br /> .... vl..!.4:lr 1-I-- '- - � ---•-"---- -- - ------- - ----- ----------- _...._Title -----I1 � _l��_.�....-___..__-__._.. <br /> (Plot plan, showing size lot;lllocation of system in relation to wells, buildings, efc., can be placed on reverse side? <br /> J� I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------- ------------------------------ ----- ------------- ------ , <br /> -- �---�J--- DATE--------�-��---- --.L�--_--�-. ; <br /> REVIEWEDBY ��•---------- -----------------------------------------------I---------I------------------------ DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED---- -------------••--___.......---------- ----•----------------------------------------- DATE------------------------------------------------------------- <br /> Alferefions and%or recommendations:----__---- ---- --------- ___ _._.. ----•-- ____. --_. i <br /> - ,� �� - .z ..•...............` c �-;---------------------.--..-------------------- <br /> i <br /> ------------- -----------------------------------k--------------y--•-----------------------------------------------------------•----------•------- ---•- <br /> - •---------------------•-----------•-------•----------.-_.__---.--------.------•-------------------•----------- <br /> FINAL INSPECTION BY----- I <br /> Z <br /> Date- <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 Lodi,California Manteca,California Tracy,California I <br /> 4w`fy8 9 REVISED 8-99 YM 5-61 ATLAS �J7i <br />