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FOV OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------- - ---- ------------ ' S> <br /> ��- ------ (Complete-in Duplicate] <br /> Issued <br /> _ ___ _ This Permit Expires 1 Year From Date Issued Date ---__S� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal4 the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. ! <br /> - 4- t ' - �f""-t<•---------- <br /> --------------------------------------------- <br /> -----------------F--`-JOB ADDRESS AND LOCATION----- .-_ <br /> _. -_-._.== =R = <br /> -•-•------/4 ------------- 1 ----Owner's Name 'k <br /> t <br /> V <br /> Address-_ <br /> ---------------------------------------------------------------------------- <br /> Contractor's Name------ Phone. •- <br /> Installation will serve: Residence ®—Apartment House ❑ Commercial ❑ Trailar Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --- Number of bedrooms _-/-. Number of baths. '. Lot size ------------------------ <br /> Water Supply: Public system 9?__`Community system ❑ Private E] Depth to Water Tablefft <br /> 47 <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9?-Flardpan ❑ I <br /> Previous Application Made: (If yes,date.------------------ ] No ?��New Construction: Yes ❑ Nogn-- 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 /> Se tic Tangy: Distance from nearest well-----------------Distance from foundation------------.-------Material -----------------.------------------------------ <br /> Xj; No. of compartments--.--..------------------Size--------------------- -------:---Liquid depth..-----: Capacity-------- ---- -------- t <br /> Disposal Field: Distance from nearest well...--------------Distance from foundation--------------------Distance to nearest lot line-_____----.----_ <br /> Number of lines.----------------------------------Length of each line----------------------------.-Width of french----------------------------------- <br /> �n <br /> Type of'filter material--. ---------------------Depth of filter material- <br /> ----------------.-----Total length-------.-----------.---------------------- <br /> "1 <br /> � 6 <br /> Seepage Pit: Distance to nearest well__--_"'~ ..-_-__.Distance from fo�dation__.� ___.Dista to nearest lot <br /> [ems Number of pits-_ material_lSize: Diameter—-------------------Depth is ._--------------------- <br /> Cesspool: <br /> -__--_ --------..- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation--- -.---_._.--.. _.Lining material------------------------------------- <br /> ❑ Size: Diameter- --------- ----- -------- - ---- Depth---------------- ---- - ----- Liquid Capacity gals. <br /> Privy: Distance from nearest well-------- -------------- -----------------------Distance from nearest building-------------.---------------------------. <br /> ❑ Distance to nearest lot line------- �;____..`° :_......... - -- - <br /> t le. <br /> /� � <br /> Remodeling and/or repairing {describe)-------- ----- f ------ --------------------- <br /> ! - - -------------- ---------------------------------------------------- <br /> -------------------------------------------------------------------- ------ -------- <br /> - ---------------------------------------------------------------------------------------------- <br /> ---------- c ------------------------------------------- ----------------------------------------- <br /> I hereby certify that.I have prepared this application and that 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)--------- ----- ------------•---- '' `� /. __ .. ----- -------•------------- .( /or Contractor) <br /> --------------------(Title). � �------------.... <br /> BY:-------------------------------- ---------- ._.� { , <br /> (Plot plan, showing size of lot, location f stem in relation to wells, buildings, etc., can be :placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ,�. <br /> APPLICATION ACCEPTED BY--------------- -------------------------------------- --------------------------------- DATE-------- -----�� -- - - <br /> REVIEWEDBY----- --------------------------------------------------------------------------- ------ DATE---- ---------------------------------=--------------------- <br /> BUILDINGPERMIT ISSUED-------- -- ----------------------------------------- ------------------------ ---------- ----------- DATE------------------------------ ------------------------------ <br /> AAratia s and/or reco m nd tions:.---------------- <br /> s,�`t " ------------ , ' ------------------------ .------------ ---- <br /> -------- -------- ..................... . --------------- ---------- - ---------- ----------------------------- <br /> ` � .. <br /> FINAL INSPECTION BY:- --- ------- -- - - - ......................... <br /> ----------- --------- - Date........ ---------------------------- <br /> f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br /> b <br />