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fUK UFF[CIt USE: <br /> - - -ate---------- ---- <br /> -------------------------------------------------- - <br /> --________________ __._____..__.___.___.__------ --.-- APPLICATION FOR SANITATION PERMIT Permit No. .;.B._ ..9 <br /> ------ <br /> --------------------------------------------------- {Complete in Duplicate} Date Issued <br /> --- ------------------------------------------------- --- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No, S49, <br /> JOB ADDRESS AND LOCATION--- ef...... <br /> Owner's Name--------- 'r- � Phone <br /> Address----------•-------L. ------ ---.. ------L <br /> Contractors ------ <br /> Installation <br /> ----Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms __Z.__ Number of baths _/__._ Lot size ------S70_><._�Z <br /> -------- ------------------------------- <br /> Water Supply: Public system Q- Community system,-El 'Private ❑ Depth to Water Table _G-s_ ft, 1 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (?J- Hardpan ❑ <br /> Previous Application Made: (if yes,date--------------------) No b� New Construction: Yes ❑ No FHA/VA: Yes ❑ No Z;-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__A--------Distance from foundation---/_e----------Material___ -�? !- - --------------- <br /> No. of compartments.--------------------Size---, ,{- _ � Liquid clepa h--.-___�V----_---____.----Capacity__X_a; :------ <br /> Disposal Field: Distance from nearest well---- _.__Distance from foundation---45�----------Distance to nearest lot line-4---- -------- <br /> Number of lines_f__------f_-_-------- Length of each lin e---------`t_U_/---------Width of trench-___.L._-P--_____________________ <br /> Type of filter material___ _u_ _ _____Depth of filter material-____-/.if.... length_____.` �_---:____________________- � <br /> I C f -r <br /> Seepage Pit: Distance to nearest well_-.._�-________Distance from foundation___.1...__.•..___.Distance to nearest lot line___.___-___-- I <br /> [ � Number of pits--------f-----------Lining material---- .......Depth_ ._-$ ------------------ \ k <br /> Cesspool: Distance from nearest well_________________Distance from foundation.-------------------Lining material--------------------.--- __.___._____ <br /> ❑ Size: Diameter----il---------------------------------Depth-------------•--------------------------------------Liquid Capacity---.------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----____-_---._--_______________.___..__. <br /> ❑ Distance to nearest lot line------- ----------------- ----------------------- ---------------------------------------------------------------- ` <br /> " r <br /> Remodelingand/or repairing (describe)---------------- ----- -------------------- ---------------------------------------------------------------------------------------------------------- <br /> `----------------------------------- ----------- ------------------------------------------------------------ .---------- <br /> ------------------------------------------------------------ --------------------------------------------._ i <br /> -------------------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------ ----------- ---- ------------- <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 /> F <br /> (Signed)-------------•-------------- -------------- --=---:,_---7f-- - -----f---------------- --------------------------------------------------- - (Owner and/or Contractor) <br /> By:-------------- ------------------------------------------------------------------------------ `-------(Title)------- -- ------------------ ---------- ---- ------ ------- <br /> "•(Plot plan, showing size of lot, location of system in relation to.wells, buildings, etc., can be placed on reverse side). <br /> F DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- ----- ----- - DATE-------- �� <br /> REVIEWEDBY---- -------------------------- - / -. . ---.-..---__ .._---.------ -------------------------------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED---------------- ----------------------------------------------------------------------------- DATE-------------------------------- ---------------------- <br /> Alterations and/or recommendations-------------------------- ------- --------- - -------------------------- -------------------•------•------ •----------------------------------------------- <br /> i <br /> ---------------------------------------------------•---•---•------------------------------------------- <br /> ------------- <br /> --------------------------- --AAN <br /> ---------------------------------•--------------------•---------- •------------------------------ -------- --- ----------------------------- <br /> FINAL <br /> ----------------- ----------FINAL INSPECTION BY: Date7� 6 ................. <br /> JOAQUIN LOCAL HEALTH DISTRICT . <br /> 1601 E.Hasellon Ave. 300 WesT Oak Street 124 sycamore Street 205 West 9th Street ` <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r <br />