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FOR OFFICE USE: V-6- 0 '74" <br /> --------------------------------------------------------- <br /> -------------------- - -- --------- - ------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. .... <br /> ------------------------- - -- --------.--- -------- f <br /> --._._ This Permit ECprirese Ye Du plicate Date Issued Date Issued <br /> From <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 A LOCATIONs_, t � - _- <br /> -0 <br /> Owner's Name Phone <br /> ne.. <br /> ' ----------------------------------------------------- <br /> Address <br /> I <br /> :... f -------�-- <br /> Contractor's Name- - -----` ___ - ----- ------ Phone-------------....----- <br /> Installation wlll serve: Residence Apar ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> e i <br /> Number of living units: __�_._ Number of bedrooms _ _ Number of baths__—Lot size __ /fl____ _ a______________-_--_____-- <br /> Water Supply: Public system ❑ Community system ❑ Private [3r 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 ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic=tain or cessp oo I }permitted if public sewer is available rvithili 204 feet.) - Y <br /> Septic/Tank- Distance from nearest well---✓r�_�___Distance from foundation----4d___r__._.Materiai _..________- <br /> No. of compartments_..-_":;----------------Size_�,�_/ _ __X_'�_-_Liquid depth ------- __...___capacity__ 60 <br /> -. --- <br /> I <br /> Dispos Field: Distance from nearest well- �._Distance from foundation <br /> ----/-.&----------Distance to nearest lot line_ i__________ <br /> V Number of lines -----------�-----_ Length of each line`]�Q_-L Q_-A?0%idth of trench....-2-----Z------------------ <br /> Type of filter materia}___-_ ._ ._ _Depth of filter material_._.l_57__'.`--------Total length____.._.�:J---------------------- <br /> Seepage Pit: Distance to nearest well______________________Distance from foundation_.______-________.Distance to nearest lot"line----------------- <br /> ❑ Number of pits--- ----- ----- <br /> -.-.--Lining material...................... Size: Diameter-----------------------Depfk-..------------------------------ <br /> Cesspool: Distance from nearest well ________________Distance from foundation----------------- ..Lining material------ ------------------------------- <br /> ElSize: Diameter- -- --------- ----- ----------------Depth--------------- .................. Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_...__-___.______.___________..__..____--- <br /> ❑ Distance to nearest lot line - - ------- - ---------------- ----------------------------------------------------------------------------- --------------- <br /> Remodeling and/or repairing (describe)---------------------------------- -------------------------------------------------------------•-------------------------------------------------------- <br /> ------------•-------------------------------------------- --------------------- ------------------------------- ------------------------------------------------------------ ------------ - - .-- <br /> ---------------------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, nd. rules and regular; of the San Joaquin Local Health District. <br /> (Signed)------------------- - . ------------------ -- - ---- - ------- ------------ -- ---------*(evgar and/or Contractor) <br /> By:------------ h ----------- --- ----�----- --- <br /> (Plot plan, showing size of lot, location of sys em in relatio to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___ _._- _____________ DATE--- -7..rG <br /> REVIEWEDBY----------------------------------- ----------- ---------------------------------------------- DATE------------- -------------- ----------------------------- <br /> BUILDINGPERMIT ISSUED-------- -- --------------------------------------- - --------------------------- ------- -----. .- DATE--------------------------------- ------- ------------------ <br /> Alterationsand/or recomffendaticins:---------------------------------- ---------- ---- ----------- --------------------------------- --------------------------------- --------------------------- <br /> --` ------------------ ---------------------------------------------------------------•--------------- -------- -------------------------------- <br /> r -.r--------------------------------­----- ------- ----------- ---- --------- <br /> FINAL INSPECTION ------------------- Datex.> .-- �- �p <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1691 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />