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FOROFFICE USE: <br /> -------------------=------------------------------------- <br /> ----------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. .9.��3 <br /> ­­------ ---- -- ---- ----------- ---- --- --- (Complete in Duplicate) _ .�ld`–11 <br /> A lication is hereby made ao the San Joaquin uiPngLaclal Health Dist <br /> From Date Issued Date Issued _______________________ <br /> i ------------------- --------- - ---' -- - ----- <br /> - - <br /> pp y q or a permit to construct and install the work herein described. <br /> This application.is made in compliance.,wit County Ordinance No. 519. <br /> xuq,��+•= <br /> JOB ADDRESS AND`LOC TION 1: '#�� -------- j--------------- <br /> ---------- <br /> Owner's Name.-------- / ------ Phone------------------------------------ <br /> Address <br /> ------ - - <br /> Address------------- - - '------. ..:. <br /> . i 1 <br /> Contractors Name - -- - Phone. ------------------- <br /> a <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ (Other ❑ <br /> Number of living units: _"'__ Number of bedroomsT_. Number of baths ----____ Lot size _________________________at <br /> __________________________________ <br /> i , <br /> Water Supply: Public:system ❑ Community system Private ❑ Depth t ater Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand [j Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Mader (If yes,date__----_________-__-- No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> { <br /> TYPE�OF INSTALLATION AND SPECIFICATIONS: I <br /> .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i Septic ank: Distance from nearest well-----Sa------Distance from foundation-----4 ----- -_Material---___ ___ ____________-___. <br /> No. of compartments—_ 3_ _ Siz ��ll___�_ ���/��`Li uid depth______ _._�.._,______Ca acit r�_VPA ____ <br /> P ............. <br /> s r <br /> D.isposa field: Distance from nearest well__- 13-_.-_Distance from foundation_____I�P__-_____-Distance to nearest lot line_ _________ <br /> Number of lines-----------L____ . Length of each line___--/_0__Q__�_____-_.Width of trench-__ ------------------ <br /> Type of.filter material----� _R----_ --Depth,of filter material---1T--`_r___-_____-Total length-----/___0_a___r__________-______ ._ <br /> i Distance to nearest well__%.`d'_6__�""-_-pi`sMnce from foundation----l._;__ ------D��ance to nearest lot line__ ----------- <br /> Number <br /> �______ _ <br /> ❑ Number of pit�'___/-------------- material----cg-j _•_-_--Size: rV__/ Depth---- -------------'-------. �. <br /> I, <br /> Cesspool: Distance from:"a rest well------------------Distance from foundation------------___-----Lining <br /> material-__.______._____-_.___-_-----_-__-_ <br /> ❑ Size: Diameter_-�________________________---'---.Depth- -------- - ------------ - - -_Li Liquid Capacity_--------------------------gals <br /> .� <br /> t -_Distance from nearest building Privy: Distance.from,nearest well g <br /> ❑ Distance to nearest lot fine------ '---- -- ------ ----------------------------------------- ------------------------------------------------------------ <br /> Remodeling and/or,repairing (describe]:____-.________-- _- "---_ ------------- <br /> ---------------••-•----•- - _ - ----------------------------------•--•----------------------:---------------------------------------•-------------------------------------------------------------------------------- <br /> --- -------------------------=--------�-- <br /> 1? ere ce that I have prepared this a,pplication'and that the'work will be done in accordance with San Joaquin County <br /> and ances, S+ e I s, and-rules,a4-61s" .of,+he-San Joaquin Local Health District. , <br /> ,5 gned)• ---------••- Y_' Y and/or Con+ractorl <br /> I B � }--=--- --�- - --- - --:- -----•----- -----------•- Title ------(Plot plan, showing size of lot, locarelation to wells buildings, a+c., can be placed on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED?BY ' -- ---- DATE------ --Pf--�-f/---- ---------------------- <br /> REVIEWED <br /> --- ---------------- <br /> REVIEWED BY----------------- -----7--------------- ---------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED--------------------------------------------- - -- DA•TE_-------------- <br /> Alterations and/or recommendations____________________________ <br /> - = ----------------------•---------------- ------------•-------------- <br /> ------------------------ <br /> -----------------------------------------------•------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------- <br /> -----•---------- - ----------------•- -------------------------------------------------------------------- -------------------------------------------- ---------------- - <br /> I } <br /> FINAL INSPECTION BY: ------------------------- Date--'----y''r�+ -----.-_--------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> I <br /> t ES 9 FEVfSED 6-59 3M 3-•63 F.P.CD, <br />