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FOR OFFICE USE: <br /> r <br /> ...... ..-- ........`............... APPLICATION FOR SANITATION PERMIT Permit No. ....�✓� <br /> ..............._.................. ------- .._.._ `%J <br /> ................. .. (Complete in Duplicate) Date Issued .-.---r[• <br /> ....•................ This Permit Expires 1 Year From Date Issued <br /> Applica+ion is hereby meds to the San Joaquin Local Health District for a permit to + �t work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 005 <br /> -/4t)- II <br /> r <br /> 24,06 { Ne '"_O4 . ............ <br /> � ?_........._ <br /> D CJOB ADDRESS NOATI � Phone........ ----_----._.-..._ <br /> - - - <br /> Owne's Name................. <br /> . <br /> /Zf..,Xai-_--------- ..........-....................---............._-..._... ...._..-._. <br /> -............................... ---- Phone....__.._-......... <br /> Contractor's Name.... .-----••ea-- ......--................................._......-._.-----••--- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial M Trailer Court j4 Motel ❑ Other ❑ <br /> _.... ... <br /> Number of living units: ........ Number of bedrooms ........ Number of baths Lot size ._�.. y vie._r�"..................... <br /> Water Supply: Public system ❑ Community system ❑ Private ® Depth To Water Table .7 Q- 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....................I No Rl Now Construction: Yes ® No ❑ FHA/VA: Yes ❑ No❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.................Distance from foundation.................Material......... .....__......._-- ............ <br /> No. of compartments...._...................Sim....................-•----"'--Liquid depth---------_.............Capacity..............._...... <br /> Disposal Field: Distance from nearest we11..1Pb_:....Distance from foundation..2�b'..f....Distance to nearest l ..... <br /> Number of lines-_141L. Length of each line.... -------Width of trench...�:..-_f............•...... <br /> Type of filter meterigl �. 1 Depth of filter material.-j?..............Total length... <br /> �J�f?� •••••••••---••-------•"- � <br /> Seepage Pit: Distance to nearest well.....................Distance from foundation.._-_............Distance to nearest lot line-------_....._ E <br /> ❑ Number of pits......---_...........Uning material........"..............Size: Diameter.......................Depth_---.---.- -----------_--- <br /> Cesspool: Distance from nearest well..._............Distance from foundation...................Lining- - - -- - -material.........................--...._... Z <br /> ❑ Size: Diameter_.............. ----- ••- ..._...Depth------•-•-----.....................- -.----...Liquid Capacity.. ---•-•-- -----------.9 <br /> Privy: Distance from nearest well..................._._.......................Distance from nearest building...._._.._....._.._-._..._..... <br /> .... <br /> ❑ Distance to nearest lot line----......:...........--------_._....-----------....-•••------...._----.._.....__..........•..............__...... ..... <br /> Remodeling and/or repairing (describe):-....... --. . ......._ _ <br /> _... ^......._._._.......--------------.........__..-.........•...__.....-.....-- - - ................................-........................_........................I. --------..- <br /> .......................................-•-•........................----.. ....----_-.......------.............._....----".._---.........----••------.....---------•------...-.----....-............._.. <br /> I hereb certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> ordinances, Late laws, and rules and re ficins of the San Joaquin Local Health District. <br /> tP��e• ........ ....._- -- ..----"-----""•• ........ .-- "- nar and/or Contractor) <br /> _ ....... I.....•. --•--•----....-.--4Ow <br /> By:--------------._....•••......----•.........-- ....:... .........._.............. ...:• -- ----•---•n tle).------.... ..............................- - ..... <br /> (Plot plan, showing $ize of lot, ocafion of system in relation to wells, buildings, etc.. can be placed on reverse side} <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. -- ......-...-----................ .......•.............. <br /> - <br /> REVIEWED BY.............--------........................................._.................._.---•-----.._......_.._..__..-.. <br /> DATE................. <br /> BUILDING PERMIT ISSUED---__.......---- ... .............. DATE.........._............... ....-------_---------------- <br /> Altera8ons and/or recommendations:................... .......................... - ................................____...................................... <br /> ..... <br /> .-----------------------------•----- ------- <br /> _..............__..........................-- -t... _� <br /> { <br /> _ ----• •.. .._. <br /> ...............I....... ........ ..............•-----_......_•-----...••----..................•-•--...... ... ...... <br /> - <br /> FINAL INSPECTION BY:............ ........................... <br /> ........... Date---.............._..----......................._.._._.._................ <br /> • SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South AM <br /> mwlcun Strrat 300 West Oak Strt 124 Sycomen Strwt 205 West 9th Street <br /> Stockton,Califomia Looll,Cailfomta Ment.,Ccllfomia Tracy,California <br /> ES 9 REVISED 8.59 ZM 5.6Z ATLAS <br />