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APPLICATION FOR SANITATION PERMIT <br /> Permit No. ._�1�---��------- <br /> II c� <br /> (Complete in Duplicate} Date Issued .��'�D-J_�--1 <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. ,, P't <br /> 1-1 <br /> JOB ADDRESS AND LOC�A ---- <br /> -� -� -------------- <br /> Owner s Name.---- - --------- - <br /> --------------------- Phone------------------------------------ <br /> ... <br /> ` ------•------------------------------------------------------- <br /> -------------- ----- -- -- -------- <br /> -, <br /> Contrac#or's Name = ------------------ -------------------------- Phone: <br /> -- - ---------------- ---- <br /> 4 <br /> Installation will serve: Residence Apartment House"g-'Commercial ❑ Trailer Court ❑ Mot 10 ❑ Other ❑ <br /> Number of living units: .-/-- Number of bedrooms <br /> Number of baths ___ Lot size _d4 X---� --------------------------- <br /> Water Supply: Public system (. Community system El Private F1 Depth to Water Table _Idp ft. <br /> Character of,sbil-to a depth of 3 feet: Sand ❑ Gravel F1Sandy Loam [I Clay Loam [I Clay E] Adobeardpan F] <br /> Previous Application Made: Yes ❑ No New Construction: Yes El No [ FHA/VA: Yes p N El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> ptic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------ <br /> - <br /> ' No. of compartments----- - ---------- ------Size--------------------------------Liquid depth--------------------------Capacity s <br /> P�ial ield: Distance from nearest well____ __Distance from foundation-- �_ _-_---.Distance to nearest lot <br /> Number of lines-------------------------- Length of each line_ � <br /> �"d' Width of trench •r� <br /> Type of filter material--/I-/"41--Depth of filter material-- ft -------Total length-_- `a�--------_- --------' - ` <br /> - - _ Distance from f ndation_-> V- .----_---.-Disatance to nearest lot line---- ----_ <br /> 4eaog,� <br /> Distance to nearest well___----' tsl2De tn___-�._-Size: Diameter <br /> ,( <br /> Number of pits-------!------------Lining.Material-_- ------------------------------------- <br /> Cess <br /> -___---------- <br /> Distance from nearest well--_------------Distance from foundation--------------------Lining material <br /> tv <br /> DepthSize: Diameter------------------------------- -- <br /> -=--------------------------•------------------ ---Liquid Capacity- --------------- ----------gals. <br /> ----- ----------__---Distance from nearest building d <br /> Privy: Distance from nearest well------------------------ - g"------�-"-- ------------- ---------- <br /> ❑ Distance to nearest lot line------------------------------------ ----------------------- <br /> Remodeling and/or repairing (describe)-------------------------1� .- - <br /> 4�-90-19-1 <br /> ----------------------------------- <br /> ---------------------------------------------------- <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 /> --- <br /> ---- /or Contractor) <br /> Si ned <br /> - ------------- - - - <br /> ------------------------------------------- <br /> By:---------------------------------------------------- - --------- ----- ----- ---------------- -- <br /> (Title)---- <br /> - ------ <br /> - - ---- -- -- <br /> (Plot plan, showing size of lot, location o stem in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> L APPLICATION ACCEPTED BY-_`rt�-'ja- ----------------------------------------------------------------------- PATE ,� <br /> REVIEWED8Y -------------------------- -----------:-- ---------- ----------- ------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE <br /> 3 ----------------------------------------------------------------------- <br /> Alterations and/or recommendations_______________________ ----------------------------------------- <br /> ----------------------------•_._.- .: ---- -----------------------------------t------------------------------------------------------------- - <br /> --------------•-------- -------------- <br /> �' -----vii I .-5---------------------F R5�:--------------------------------------r-- ----------------------- <br /> - 1N- �_..� t�I- T�_©r� ----------C__s.K, r-/ A-i.-� <br /> ----------- <br /> ---- <br /> ------------------------------- <br /> ---------------------------I------------------------leTy, ------ <br /> OF <br /> / <br /> Date- -------- -v-- ------------------------------- --- <br /> FINAL INSPECTION ---- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street ) `i A 2132`Sycamore-Street(`y 814 North "C" Street <br /> Stockton, California <br /> Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 1.57 F-P.CO- <br />