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FOROFFICE USE: <br /> '3 <br />------------------ - __.-_________________ ____________ APPLICATION FOR SANITATION PERMIT Permit No. _.... f•��3 <br />---------------------------------------------- -------- (Complete in Duplicate) Date Issued ..... / <br />--------------------------------------------------- ----- This Permit Expires 1 Year From Date Issued <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 /> ADDRESS AND LOCATION----- jJOB <br /> Owner's Name----- --------- - Phone-•------------------_------------- <br /> Address................ <br /> ---•-----Address----------------7TY---------- ----•--- nQ C <br /> Contractor's Name.......................................... <br /> t Q <br /> . ---•-•-•••-....--•--------------•-••---..._..................---................• Phone......................................... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial [+e Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ........ Number of bedrooms .------- Number of baths -------- Lot size _.�. � �� <br /> Water Supply: Public system ❑ Community system ❑ Private IP(Depth to Water Table ________ 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--------------------) No 2-•- New Construction: Yes Er"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.) N <br /> s <br /> Septic nk: 2, Vi/-Distance from nearest well___ `_--Distance from foundation._7�______.Material--------_....................................... <br /> No. of compartments t _-Liquid de th_______________________ __Ca Capacity - <br /> P ------w..Size--•-----------------•-•--••--- q P�, - P tY-----2•-.--•��------�r-� <br /> Disposal Field Distance from nearest well_. __.._Distance from foundation.__. __..Distance to nearest lot line...' <br /> Number of lines__________________ ._.... <br /> -,� --- --------Length of each line------•--�}'-----f�---...Width of trench-------�,,.-..�................ <br /> Type of filter mate ria I._�'a��-------Depth of filter material____ff1_'___ ______Total length............4.Q__ _________________ <br /> Seepage • : Distance to nearest well/ _.___Distance from fo nclation___!f�d__�._....Distance to nearest lot line_________________ <br /> Number of pits-------/------------_Lining materia3___1v!;r_ __.Size: Diameter------ Depth---- <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 /> Remodeling and/or repairing (describe)------..j�c ----... - • ---•---------- _. ..•-- �- •. •-.- ..: <br /> --- <br /> ------------------------------------- ----------------------•---------------...--------------------.._....----------------------------------------------------------------------------------------------- ------------------- <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)-------- ...... ----------------------------------------------------------------------------•-••----------•-----(Owner and/or Contractor) <br /> By:-------------------_---------------------.....----------------------•------------------------------------------------------------(Title)------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ----------- --- ------�ej_ -- -- .___-- _-_-- DATE_-- -.; _ -- ___-- _-- /�5-? <br /> - L ------------------- <br /> REVIEWEDBY.... ---- ------ --------•-------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED--------------------------------- --------------------------------- DAT ---------- _ <br /> Alterations and/or recommendations:.. �_E_ T _____.; 'll____��� t _l _ ���- _______________________ <br /> -------------------•.-------•--------------------------••----- ­­------------------------------------------- ------------------------------------------------------...........------------•----------------•-------•-- <br /> ------•...........................................•--•-•-••-------....----------------------- ••--•--------------------------------------••----------•--------..-..-----•----•--.......-------•-•---•-------------------.... <br /> -- --- ------------- <br /> FINAL INSPECTION BY:- --- --•---: .-- - ---- -- ---- Date---�--- --- -•- -•- --�-------------••-• ---------------- <br /> SAN JOAQUINILOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,Coiifornia S <br /> E6 9 REVISED 6-59 2M 5.61 ATLAS <br />