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FOR FFICI,USE: --- <br /> .q.. <br /> � z3 _��-------7�--- Permit No. ---•!--••-•---! ------ <br /> APPLICATION FOR SANITATION PERMIT <br /> ---- ---- ------------------------------------------- ( p P � ?� e4/ <br /> -------- <br /> --_--- Com lete in,Du licate) - Date issued _._.___.-.-��--••- <br /> •�- This Permit Ex ire's 1 Year From Date Issue <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. <br /> JOB ADDRESS AND LOATION...1 ----------------•------ -------------------------•---------------------------•-- <br /> ,��--�dr'---�'�`--- -- -- --•-• - '- <br /> Phone <br /> -------------- ------_---=- ,------------ <br /> - <br /> Owners <br /> Address--------- f 9 ------ ---- <br /> -------------•---•--••----- <br /> --------- --------------------•------ =...__. Ph <br /> one----------------------------------- <br /> --- <br /> Contractors Name-- -- - ��•:•---•- --•-••-----•- - ,. t <br /> Installation will serve: ;Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ <br /> Motel ❑ Other ❑ <br /> !. <br /> Number of living units: _- Number of bedrooms _____ Number of baths _ Lot -- <br /> size ..- <br /> -Q__, `.. ---•---------------- <br /> Water Supply: Public system Community system E' Private El Depth to Wafter Table -_ ft. <br /> Character of soil to a depth of 3 feet: Sand C]. Gravel ❑ Sandy Loam ❑ Clay Loam El Clay C] Adobe Hardpan ❑ <br /> # FFiA/VA: Yes El NO <br /> Previous Application Made: (If yes,date__-.__-:---------'---1 No. New Construction: Yes �Q 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_ = --- -- --- 'Size- -----------•-••--------------Liquid depth-- -----------------------Capacity--------------- ------- <br /> I ❑t T undation.,___ ---------Distance to nearest lot <br /> Disposal Field: Distance from nearest �l'W-0 Distgnce from fo <br /> --_--_--____.Length of each line_! Width of trench----- '°-=`-------------- <br /> Num[jer of lines, - _ --•- ` i <br /> t �r _De th of filter material:_ 1.vw_------Total length---- <br /> Type. <br /> _---------------- <br /> Type, of-filter material__. --_ _ P _ • - , . - t <br /> µ . - .... .E.. .. ___- <br /> i ��_ ...Distance to nearest lot line---.,X7 <br /> Seepage Pit: Distance to nearest well�✓p�[l/fP -.-:Distance from foundatson_ __ <br /> .Size: D-sameter Depth----4r - -•-- <br /> Nuirnber of pits___._--- g <br /> -----_---Linin material_-- - - ------- �-�-- <br /> Cesspool Distance from nearest well_______..----_._-_Distance from foundation____________________Lining material-_.___._--____-____.---:--•-----'els. <br /> Depth------- -------------- ------------- Liquid Capacity 9 <br /> ❑ Size: Diameter------------------------- _ <br /> Privy: Distance from nearest we�l_---------- --------------- ---Distance from .nearest building-------.------------------- ------ <br /> -:_ <br /> -'------------- <br /> Distance to nearest lot ine___-_---------------------------•-- --------i-­ <br /> ------------ <br /> -- - - �. :A <br /> :•�.. <br /> Remodeling and/or repairing �doscriUe�:: G[.a-1' •-----••-------------------•_---------•------------ <br /> L' -- - ------- -- ------------•-------------------------------- ' <br /> t - �r <br /> ------------------------------------•----------------_----•---------------------------- R <br /> ------------------------ <br /> ------ -! ---- ---•---•------- - ----------------=------------- •--------- ---------------•--- �, =- <br /> 1 hereby certify that I have prepared this application and that flie work will be done in accordance with San Joaquin Coun <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> fOwner and/or Contractor) <br /> h ----- <br /> (Signed). <br /> -------- <br /> ----- <br /> --------- ------------------------------------------------------ <br /> ---- <br /> ------------------- -----'�- -..------------- <br /> `$ t loco of system in rete}ion to wells, buildings, etc., ca{bele) <br /> < . <br /> y <br /> Y=-------- �� -- place on reverse i e. - <br /> (Plot plan, showing size of lot, _ <br /> f .�. FOR DEPARTMENT USE ONLY A <br /> ---------------------- <br /> APPLICATION ACCEPTED BY___-.C_ ± -S=--------_----- - <br /> ---------=------------------- DATE__ ..... <br /> REVIEWED BY---- -----------------------------•------------------ <br /> -----------•----- DATE-------------------•--------- -------------••--------------- <br /> DATE <br /> BUILDING PERMIT ISSUED--------------- -- ---=- = s - ' <br /> Alterations and/or recommendations: 3_-Sr�l_= 1 -•--`-�-•_--= J __w._ _I _.------=---------- <br /> --- - <br /> -----•---------------------- <br /> 'U" <br /> '--------- <br /> ----------'--------- --•--•--------- -------------•---- -------- <br /> -- ---------•------ <br /> ,,`� ------ -- --- --------------------------- - <br /> z <br /> v- <br /> / f� -•--- -• ---- <br /> JL �S . .... � s .: ' ate_-.�_.-�.--�---• -E°-j---------`"--_-.:---':. -�---- - <br /> FINAL INSPECTION BY:�'---- :..---•------ ------------ ----- <br /> SAN JOAQUIN LOCAL HEALTH .DISTRICT - - . <br /> w- <br /> 4— V <br /> 130 South American Street <br /> 300 West Oak Street 144 Sycamore Street 205 West 9th Street <br /> Stockton,California I Lodi,California Manteca,California Tracy,California <br /> E6-9 R9V10r0 6.59 I.P.0 O.SM 5.60 <br />