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--- �------FC7ROFFICE USE; <br /> c"Y- 3r <br /> ------ ---- - -- - ---------------- <br /> --------------- - APPLICATION FOR SANITATION PERMIT Permit No. -- _.-. ._.� <br /> ----------------- -------- ------------------------ (Complete in Duplicate) Date Issued . ................... <br /> Z <br />------------------------------- .----------------_ This permit Expires 11 Year From 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 w-th Couunty Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION _- f l •,I -. oo <br /> 'd1c------•-•------------- ..........__-----------------.. ----------• <br /> Owner's Name --•------------------- ----•- -------..............------------------Phone.................................... <br /> Address.. r ---••--•--•-----•---------------- <br /> Contractor's Na 1e --- --------- ---- -------------------------------------------------.............................. Phone..--............................... <br /> Installation will serve: Residence IX A�rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1___ Numbeir of bedrooms Number of..6?ths ./.... Lot size --------- .......... .' . ............ <br /> Water Supply: Public system J& Community system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No Z "New Construction: Yes $4 No ❑ FHA/VA: Yes ❑ No�] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 3 J <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well----l�-•-Distance from f9undation----- /a-------.Material......... ... <br /> No. of compartments_.--_---Z___.------.-Size-___4.L. __?'1t_-7:.Liquid depth--------�-------------Capacity--------------- <br /> 0 ' <br /> Disposal Field: Distance from nearest well----/_P'Y9.__Distance from foundation../-45-- Distance to nearest lot line......17_.'... <br /> Number of lines-----------71----. .-----_- Length of each line...-.--- -?---------------Width of trench--------!;�L*_ter <br /> Type of filter material..... m ._-Depth of filter material----- ------Total length-------- .................... <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- <br /> El Number of pits----------------------Lining material----------------------.Size: Diameter----.------------------Depth-----------------..--..._--------- �. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material------------------------------------- <br /> ElSize: Diameter---- ----- ---------- ---------------Dept h------------------=----------------------- ------..Liquid Capacity............................gals. <br /> Privy: Distance from nearest well----------------------------------------- ------Distance from nearest building--__-------__------_...___.._--.---..---. <br /> ❑ Distance to nearest lot line------ ----•-•-------------------------------------•------....------.....----------------...------....-•-------------------------------------- <br /> Remodelingand/or repairing (describe):------------------------------------------------------------t.....................................I...................................... ....... <br /> -•-----•----------•----------------•-...----.-....------------_------------'--------------------...------...---•--------------------...-------------------•--•---••--------•-------------------------.--------------------- <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)----- � <br /> �-•------------------------------------------------•-- ---------•- •-----•------------------..-.(Owner and/or Contractor) <br /> Sy:------... - •---• - - -------------------------------------------(Title)--------------------------=------------- --- - -- -------------- <br /> (Plot plan, showing size lot, location elf'system in relation to wells, buildings, etc., can be placed on reverse side). I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..--- - ----------------------------------------------------- DATE--------- l¢ ... <br /> REVIEWED BY------------- - .:-..---•------- <br /> -------------._ DATE..----------------------. <br /> ------ <br /> BUILDINGPERMIT ISSUED-........--••--- ----------------------------------------------...r.._ ----------------------- -------------...-----------.-.-.- <br /> ----------------- <br /> Alterations and/or recommendations------------------------ ------------- -----------•-•---•--•-----------------------------...---------.-- <br /> --------..-•--------•--------------•--- <br /> -------•.............•---------•---•-------------...-.._..-----------------•-------------------------------- ----------------•--.........••-------------------------------............. ------­------------- <br /> --------- <br /> ----- ------------- <br /> .. ------- +' r <br /> �.. <br /> _•--.----__•---- - iw-_4 � <br /> -----•-------------- <br /> FINALINSPECTION BY:----------------------------------------------------------- ---- Date.-- ---•--•--•-------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wort Oak Swot 124 Sycamore Street 205 Wert 9th Street <br /> Stockton,California Lodi,California Mantua,California Tracy,California <br /> E8 9 R$VISEo 8-59 2M 6-61 ATLAS .� <br /> Y+4 ' <br />