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APPLICATION FOR SANITATION PERMIT Permit No. ...1 -.. 7 , <br /> r� (Complete in Duplicate) / <br /> + Date Issued ___�_ <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Sari 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. 01 <br /> JOB ADDRESS AND Tl � -----------------------------------------------=------------------------------ <br /> - -- - -�F <br /> .-, <br /> Phone --------------------- <br /> -------------Name <br /> Address----------- _� . : 1 --------•-----------------;--------------•---- <br /> 0 <br /> Contractor's Name---------------- /� �r-- ------- s Ph ne..._.--- <br /> Installation will serve: Residence ❑ : Apartment House ❑ Commercial ❑ Trzilar Court ❑�jMotel, ❑p Other E] Za© <br /> Number of living units: _ N ber of bedrooms _ ___ Number of baths __,___._ Lot size ___ <br /> Wafer Supply: Public system Community system ❑ Private ❑ Depth to Wafter Tablet, <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes � ❑ FHA/VA: Yes P� ❑ <br /> t i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: E <br /> (No septic tank or cesspool permitted if public sewer is available within 200,jeet.) t" <br /> t � 1 <br /> Septic T Distance from nearest well____""__.__Distancg from foundation__��--i___._.Matyial__.&_� --- - <br /> No. of compartments_.____------------Size_I��-�_ ""Liquid.depth__- f Capacity____ _ ____ <br /> Disposal F' Distance from nearest well....'------Distance from fouunnd'ation -----�__-_,____Distance to nearest lot I�-�-�-------- � <br /> �i-L_____ .Width of trench_ <br /> ber of lines---­_'_/------ ----- ---��---ff��''ength of each dine:}---- - � �---.------�-�--�-- -•-- <br /> Type of filter material__� epth of filter material____. ___.___ Total length______ _______________________-___ <br /> I / L i <br /> Seepag it: Distance to nearest well----------.___-Distance from fo dation____l�__ .Distance to nearest lot line_.--123/ - <br /> i <br /> Number <br /> a of pits _Lining. ._ma_ter.ia�l.__ -.Size: Diameter_ ........ <br /> ---------�- <br /> J <br /> Ces❑spool. Distance from nearest well-----------------Dista,nce from foundation -------------------Lining material_._.._._.______-____.____._-_-_.--___. <br /> Size: DiameterDepth - ---Liquid Capacity-- ------------------------gals. <br /> ---------------- <br /> Privy: Distance from nearest well-----_--------------------_-----_----------------Distance from`inearest building-------___.-___________.______..___---- <br /> ❑ Distance to nearest lot line------------------------------------------------------- -•------ -------------------------------------------------------------- - <br /> ' 1 - <br /> ------------------------•---------------- <br /> Remodeling and/or repairing (describe):--- <br /> ______--- -- � <br /> ------------•-•--------------------------------------------------------;-------------------------- ------------------------ ---- - -------------------- -------------- 1 <br /> -------------------------------------------------- - --- - r-- -�T- ----- ---- <br /> -- ----------- --eo� � sp --d��----------------------------------------------------- � ------------ <br /> I hereby certify that I haveprepared. iapplic + n and will be doneein accordance with San Joaquin County. <br /> . � <br /> ordinances, State laws, and rul and regalations ofhe San Joaquin Local Health Dis+ricf. <br /> -•r <br /> (Signed)--------------- -- - -------------------( r Contractor) <br /> By:------------------------••---------•---------------------- - -------- ------------ ------------- <br /> (Plot <br /> -----------(Plot plan, showing size of lot, location of' em in.relation,to wells, buildings, etc., can Rbe placed on reverse side). x <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ --------------------------------------------------------------------- DATE........., '. 0 --------------- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------- -------------- DATE--------------------•------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------- -----------------•----------------------------------------- DATE------------------------------------------------------ = <br /> Iteraions and/or recommendations-------- ------------------------------- --------------------------------------•------------ --------------------- -----------•-•----••----•-••---- ----- <br /> - - <br /> -- t - - � }�----- ------------------------------------------------------ -- <br /> �a j = <br /> ----------------------------------------------------------- ----------------------------------------------------------------- <br /> --------- - <br /> FINAL INSPECTION B <br /> ------------------- --- ---- • ----- ------ ----- Date-.- --------------------------------------------- <br /> SAN <br /> ------- ----------------------------------SAN JOAQUIN LOCAL HEALTH DIST ICT <br /> 130 South American Street 300 Wast Oak'$fleet ga y X132 Sycamore Stre6f 814 North "C" Street <br /> Stockton, California Lodi, California S Manteca, Californias Tracy, California <br /> } <br /> ES-9-2M -'59 F.P.Co� <br />