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FOR OFFICE USE: <br /> -- -- ------------------------------ ------------------ �� 7 <br /> .... . . ........ --- APPLICATION FOR SANITATION PERMIT Permit No. _--_.--.--.-.--._.---.- <br /> -- _--------------------------------------- (Complete-in Duplicate) <br /> -- This Permit Expires 1 Year From Date Issued 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. <br /> JOB ADDRESS AND LOCATION _-- __ !/1/ <br /> ,. ------------------------------------------------- <br /> Owner's Name-------- ------------------------- ----- ------------------- Phone-,------------------•---•-----••-•-- <br /> Address---------- -- <br /> - . - k � -. *­,.51� --------------------- <br /> ,p <br /> Contractor's Name------ ,----77, .�-�..�.����f� --------- ------- ---- ----------- -------------------------- Phone------ -----------------•---------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ <br /> Number of living units: --/.. Number of bedrooms _- Number of baths ___ Lot size <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table i�,- ft <br /> Character of soil to a depth of 3 feet- Sand Ej Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe ®Hardpan ❑ <br /> Previous Application Made: (If yes,date_._.------_,_.-.... 1 No New Construction: Yes ❑ No Va""THA/VA: Yes ❑ No K' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic flank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept+c Tank: Distance from nearest well-----------------Distance from foundation--------------------Material <br /> �tZtl' No. of compartments--------------------------Size-------------------- -----------Liquid depth--------- ------ --_---.-Capacity <br /> Disposal Fiel - Distance from nearest well__- -----Distance from foundation---- Ato nearest lot line---- <br /> Number <br /> --Number of lines-------- ------ ----- Length of each line.. .... Width of trench__------------------ .._. <br /> �f�``°� Type of filter materia!_ rDepth of filter material____ _____...Total length------04----" ...-.,47 ........ <br /> Seepage Pit: Distance to nearest well__.--. ->........Distance from found ation-_f4�-------Distanpe�3to nearest lot line----r�------_ <br /> . <�/1?/� Number of pits ___....._.. Lining material_ 7rKI >-.-_- Size: Diameter '.-,- .. _. o � <br /> /�sJ _Depth-.-,-p------------------------ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation.-......___------ ..Lining material------------------------------------- <br /> I] <br /> .....-----.--- ..---------❑ Size: Diameter- -- --------- ----- ---------- -- Depth--------------- ------------ -----------------------Liquid Capacity- - -------- ------------.gals. <br /> Privy: Distance from nearest well.-.---------------------------------___----------Distance, from nearest building------------------_----------------------- <br /> Distance <br /> --------------_ .Distance to nearest lot line ---------- ------ -- --- - - - <br /> Remodeling and/or repairing (describe): x. <br /> ' r- <br /> ------ ------------------------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------- ------------- 1 <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 /> (Signed) =. L- �l-4=:-- ..---- �-- - - - ------------------ -------- ----- -----{'0�ar Contractor) <br /> ���� e <br /> BY•------ ---------------------------------------- ---- ----------------- �`-=-I ✓Icy- ---------------------�T�tle) ���.�L/C:---.----- -- ... ----- <br /> (Plot plan, showing size of lot, location of system • elation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- = - - =- ---------- --- ------------------------------------ DATE------- <br /> ' <br /> REVIEWEDBY------------------------------------- ------ ------------------------------ - ---------------------------------------- ...... DATE------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- --- ------------- DATE---------------------------- --- <br /> Alterations and/or recommendations:--- ----- - - -------------------- - - --- ----------------------------------------------------------------- ---------•------------------------------- <br /> -------•-------- ------- ----------- ------------------------------------------------------------- -------------------------------- -------------------------- ----------------------------------------------------- <br /> -------------------- ---- ----------------------- ------ <br /> . 21 <br /> /f <br /> FINAL INSPECTION BY:. ------- (/ ............ Date...---- ..------- <br /> -� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 f.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />