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FOR OFFICE USE: ' <br /> --------------------------------------------- <br /> ------------ <br /> ----------------------------------- <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 Ordinanc No. 549. j <br /> JOB ADDRESS AND LOCATIONAL_ _ _ _ ________ <br /> Owner's Name- J �s ` -------- Phone <br /> --------------- ill-------- ------------------------ <br /> Contractor's <br /> ---------------•------- <br /> --------- <br /> Address- I �� ,/ ,,Contractor s Name----------- °4•-----�---`------�� 2----------- Phone-----------------------•-••-------- � <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -/----- Number of bedrooms _5__ Number of baths ___ Lot size '____ .- ____ ------.___.__ <br /> Water Supply: Public system ❑ Community system ❑ PrivateDepth t ater Table ______._ ft. <br /> S <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam Clay Loam E) Clay [—] Adobe F] Har4an ❑ <br /> Previous Application Made: (If yes,date...........:........I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> j <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Pdation--------------------Material---------------------- -------------------------- <br /> 1771 <br /> ------------ <br /> Se 0 Tank: Distance from nearest well_________________Distance from'foun.F- Liquid depth__.________-____- --_---__Capacity_____-_-__________ <br /> No. of compartments__________________________Size____________--__- -_ ----- <br /> r t7 s S i <br /> Disposa ield: Distance from nearest well__, ._____Distance from found,ation____l___.. Distance to nearest lot line_________________ <br /> Number of lines_____________ ________ __ ___Length of each line-----,Z--7-____.Width of trench------�-,/__.________________ <br /> Type of filter material__�t__�_.___._Depth of filter material__i __/_P_.___Totaf, length---411-1__________ ___________ <br /> a Distance to nearest well--___ a�._____-Distance from foundation_-- ___._-_.Di;tante fo nearest lot line_________________ I <br /> Number of pits____.. Lining material_4S Z __.___.Size: sf, De th_ _ <br /> _ _' � ial________ <br /> _____________________________.Cesspool: Distance from nearest well__________-____.Distance from foundation___._:_._._, '_ .Lining mater <br /> -' <br /> ❑ Size: Diameter---------------------------------.----_Depth-------------------------------------- _ --Liquid Capacity----------------------------gals. g <br /> Privy: Distance from nearest well----------------------------------- Distance from nearest buil`din --- to <br /> ❑ Distance to nearest lot line------ ----------------- �`r' - = -------- ------------------------------------ ' ---------- 1 <br /> Remodeling and/or repairing (describe):--------------------------- ----- ----- --::-.}----------------------•-•---------.-.- -----' <br /> I <br /> ---------------- -------------, t <br /> -----•---- -------------------•---•------- ---------------------------------------- --------------------------- <br /> ----------- <br /> # -- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance wtth`San Joaquin County. <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------- ---- ------------------- -- --- ------------- - ----------------- .0woet..and/or Contractor) <br /> ey:._.. q ...... �inrlafi <br /> ---------------------------------------(Title)------------------------------------------------- ---- - ---- - <br /> (Plot plan., showing size of lot, location of systto.wells, buildings, etc., can be placed on reverse side). _ <br /> FOR DEPARTMENT USE ONLY\ <br /> APPLICATION ACCEPTED BY <br /> --------------------------------------- DATE-----��-- <br /> - - ----------------- - ---- <br /> REVIEWEDBY------------------------- ---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------ ------------------—-------------••- ------ DATE.------------------------------------------------------------ <br /> Alterationsand/or recommendations:---------------------------------------------------------------------------------------------•-•----------...._.-•----------•-----•----- ------------------ <br /> ---------------------­ <br /> -------------------------------•----------------- --------------------- --------------------------•---------------------------------------------------------------------------•------------•----------------- <br /> -------------------------------------------•-------------------------•----- ----------------•--------------- -------------------------------------------- -----------------------------------•--•---------------------- <br /> ----------------•--------------------- -•--------•------------------------------------- -­­--------------------------------- -----------------•----------------------------------------------------------------------- <br /> FINAL INSPECTION BY:- - -------------------- Date../_'--f----w- .- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha=elton Ave. 300 West flak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S-59 3M 3-'63 F.r1.Q0. - <br /> 1 <br />