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FOR OFFICE USE: <br /> .............­......._............-1....... ......... <br /> ........................ .......................... <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ... ................................................. (Complete.in Duplicate) <br /> ._­------ -------------I----------------- 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 Ordinance No. 549. 0 <br /> JOB ADDRESS AND LOC TION_!!�/ .............. <br /> �14.6;4.4,. ........................... <br /> .............................. Phone................... <br /> Owner's Name------ .............--------- ... ......---------- -----!::!:.2 <br /> _._, -��; ..........................._—....—.......---•............. <br /> Address-.........I...... .... ..... ... ......... .......................... ....... <br /> Contractor's Name. .. <br /> -- Phone................................ <br /> -----------................................... <br /> ...... ... <br /> --- - ...... <br /> Installation will serve: Residence Apartment House C] Commercial0, Trailer Court C] Motel 0 Other 0 <br /> / <br /> Number of living units: /--- Number of bedrooms 'A'Numb baths Lot size -------------------------- <br /> Water Supply: Public system El Community systern,E3. Private' OD. Water Table ....... ft <br /> Character of soil to a depth of 3 feet-Y-Si-nU 0-Gravel 0 Sandy Loam VClay Loam E] Clay 0 Adobe 0 Hardpan <br /> ❑ <br /> Previous Application Made: (if yes,dote................... ) No [] New Construction: Yes ❑ No E] FHA/VA; Yes D No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool p;rmifted if public sewer is available within 200 feet.) <br /> I I <br /> Septic Tank: Distance from nearest w6if.................Distance from foundation_".................Material............................................. <br /> El No. of compartmenfs_J..............!t­size...............................Liquid depth_........ ... ... ......_Capacity..:...__..........._._i <br /> j <br /> Dis Id: Distance from nearest ------Distance from foundation__--4,41!...... Distance to nearest lot line.................. <br /> Number of lines.,:..--;....... ................Width of trench.... ...................... <br /> P/01pi- ",it 7. .......Length of each line.. ..........4 <br /> Type of filter material:-....-. Depth of filter ma+erlal--......11.........Total length . ...................... <br /> 1 1 <br /> Seepage Pit: Distance to nearest well.......................Di�tance from foundation..........-----,.Distance to nearest lot line-_._- - <br /> ❑ Number of pits-A......___--Lining material...................... Size: Diameter---.--..........__._...Depth....-_.__.._I................... <br /> Cesspool: Distance from nearest well................Distance from foundation _.----- -- . ..Lining material.................................... <br /> ❑ Size: Diameter. .. ........ ..... ..... .........Depth_.------ ------- -_ --------- ------- ---...Liquid Capacity..............i........_gals. <br /> Privy: Distance from nearest well................................................Distance from nearest building---------------------:------ <br /> nDistance to nearest lot line.................................................................................................... <br /> Remodeling and/or repairing (describe):.......... --------- ------ ------------- <br /> ------------ <br /> - ­- --- ---I - ----- <br /> -—------------------------------------------ I .-----------------------------------•---•----"......-- ­-------------........................................................ <br /> i <br /> ..............................I................ ..............................................................«»........._.............I......... .................. <br /> ........................i................................ ...................:.................................................................................................................................. <br /> I hereby certify that I have prepared this application and +hat 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)-----•------..... . ...... .�&............................................................................. and/or Contractor) <br /> ------ ------- ----- <br /> ----------- <br /> re , . - I 7_ <br /> ..... ..........I.......................... &7777-------------*­ ...... .... .. ...... <br /> ------ ---- "M <br /> (Plot plan, showing size of lot, location oqfisystermn in rel AZon to wells, buildings. etc.. can be placed on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ---..-.-.•---_------------------------------- DATE- ...........------------- <br /> REVIEWEDBY....--------- ..................................................._-----•._.-_._....-•---------------.-------- DATE...................................t__........... <br /> BUILDINGPERMIT ISSUED------- ..................................... ......................z...... .........DATE.......................................(.................. <br /> Alterations and/or recommendations:......................................................-,............... t.............1................................................................ <br /> - i '. # ." <br /> ............................................... .... --------_7%7�7------ —--------------!!� ...... ........................... ...................... <br /> ............. .......................................................................................................................................................I........................................ <br /> ...........»....--...«..................­_._.......J............................................................................................................................................... <br /> .............................................................. ......................................................................................................................................... <br /> FINAL INSPECTION Dtit._ ............................................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hosehon Ave. 300 West Oak St., 124 Sycamore Sir**# 205 West 91h Street <br /> Stockton,California Lodi. Zlemin Manteca,California Tracy,California <br /> E.H.92M 1-67 Voriquard Preis <br />