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APPLICATION FOR SANITATION PERMIT Permit. No. 7.-- <br /> q `>(Complete in Duplicate) / <br /> Date Issued <br /> a <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 LOCATION----'�" " �1 ------ g`g ---------------------------------- <br /> ---- -- ---- <br /> Owner's Name---- �� -- ----- ------------------- <br /> ---------- <br /> ----------------- Phone <br /> d,� <br /> Address__ r --- ------------ ------------------ ---------------------------------*---i_- <br /> Contractor's Name - h e., - _ <br /> Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i <br /> Number of living un-its: _ ____ Number of bedrooms -_. Number of baths ____ Lot size ___ _ � --------•• -° <br /> t <br /> Water Supply: Public system eC munity,system El Private E] Depth to Water Table' <br /> Character of soil to a depth of 3 feet: Sand E] Gravel; ❑.,. SSa dy Loam ❑ Clay Loam ❑ Clay [D Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or'cess ool erl ltted if public sewer is available within 200 feet.) { <br /> { p P P <br /> ank: Distance from nearest well------------ <br /> Distance from foundation Material-------------r-------- <br /> t 4 No. of compartments--------------------------Size------------------------•-------Liquid depth--------------11 ---------capacity <br /> i I�` ,eld: Distance from nearest well_________________Dis tawm—from'foundation_-r______'___.___---Distance totnearest lot line---------------_ <br /> y Number of lines----------------------------------Length of each line------------ -- ---------Width ;of trench-----------------'----------- <br /> .Type of filter materiah___.------r.j___-- epth of filter material----------------- -----Total length-----------------.:-=I_-�-------------•-- <br /> i.{ Distance to nearest lot line___--------- <br /> Seepage Pit: Distance to nearest well____---__ __Distan Vo <br /> undation�_____..,_ <br /> " `'------.Depth__ -------- <br /> _/ <br /> ------ <br /> Number of pits-_________________Lining material_ .C1____{Size: Diameter____ <br /> Cesspool: Distance.,from nearest well----.----------- Qistance from foundation--------------______Lining materia4___-_,-_.---------------------------- T" <br /> - <br /> ❑ Size: Diameter--------------------------------------Depth_--------------------� -----------------Liquid Capacity----------------------------9als. . . <br /> - --------- <br /> 1 <br /> Privy: Distance from nearest well---------------- ---------.----------------------Distance from nearest building------------------------------------------ <br /> Distance to nearest IoT line----- --------- ---•-----------------------------------------------------------•-------- ----- <br /> '?� <br /> Remodeling and/or repaEr ng (describe)------------;--- ..-.:-`,---------------------- yr <br /> ---------- ---------•------------------------------------------------------------------------------•---------- -----------� <br /> � . <br /> --- - ------------------------------------`S---------•---------------- ' <br /> ----------------------------=------------------------•-----•-------------------------------------------•---------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application,and that the work will be done in accordance with San Joaquin Co <br /> ordinances, S laws an r les and re ulations of he San Joaquin Local Health District. <br /> E `/ - ___-_- •------ Owner and/or Contractor <br /> (Signed) -`' C ``' -- -- <br /> -- --ice` <br /> -------------(Title)----- ------------ <br /> [Plot plan, showing size of lot, location of system in relation to r IIs, buildings, etc., can be placed on reverse side}. <br /> FOR DEPARTMENT USE ONLY r <br /> APPLICATION ACCEPTED BY-----------------------------------------`- ---- -- -- ---------------- DATE i j <br /> REVIEWEDBY--------------------------- -- - --------------------------------------- -----------------. DATE--- --- - <br /> BUILDINGPERMIT ISSUED------------------------------ ------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations-------- ----------------- ------------------•------------------------•-------------•------------------- <br /> -------- --------------- -----------•------------------•---•------------------•-•-------­----------------- <br /> ------------------ ------------------------------ <br /> ------------------------------------ <br /> ----------------------------------------- <br /> ----------------------------------•---------- --•--- <br /> I <br /> FINAL INSPECTION BY------------- ------------------------ <br /> Date---- . ! .."' ---------------------------- -------- <br /> 4 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M1 . Revised 1.57 P.P.CO. o(r,�� <br />