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FOR OFFICE USE: r <br /> ------------------------- ------ <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. --.-_-- <br />---------- ------ ---- _ ---------- ---------------- <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 Healfh District for a permit to construct and install the work herein descrbed. <br /> This application is made in compliancerwith County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION --�{ ------ <br /> ---"-----••---- <br /> Owner's Name------_--•------- -------- � -------- -------------_------• -- ------ Phone <br /> 2 l5 ----------------1�--------------------------------------------------- <br /> Address-----------------•-----..��.�.------- - ---� - ----------------------------------•---••---- <br /> Contractor's Name..---/ r "^' -. 'Phone---------------------------•------- <br /> Installation will serve: Residence ❑ iApartment House ❑ Commercial IM Trailer Court Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms ______-. Number of baths -------- Lot size <br /> I .� r <br /> Water Supply: Public system ❑ Community system ❑ Private ® Depth To Water Table _.0- ft.. <br /> Character of soil to a depth of 3 feetSand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam Et Clay ❑ Adobe❑ Hardpan a <br /> Previous Application Made: (1f yes,date--------------------) No NJ New Construction: Yes ® No ❑ FHA/VA: Yes ❑ <br /> No El <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_..___•_--____..._ <br /> ❑ _.Material_________________________________________________ - <br /> No. of compartments------------- ------------Size--•--------•-------------------Liquid depth----•---------------------Capacity.---•---•- -••--- <br /> Disposal Field: Distance from nearest well..�tP__I-_--,Distance from foundation..'P."�'---f..-.-Distance to nearest lo} hne__S_1....... <br /> Number of lines___ ..______._"""---- -- Length of each line____ _ .............Width of trench._. ­-------------... <br /> s Type of filter materi _ -Depth of filter material---h'-_:______._Total length__.1r�.�------------------------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation__..____...___..___.Distance to nearest lot line...____..___..... <br /> ❑ Number of pits---_"-----------------Lining material-----------------------Size: Diameter-----------..-----------Depth-_-------.-----------••.------••- <br /> Cesspool: Distance from nearest well______."______.._Distance from foundation--------------------Lining material__.___--______------•--- els. <br /> 171 / Size: Diameter------ -------------------------------Depth---"._.-•-----------------------------------------•-Liquid Capacity----_------•---------•- 9 <br /> Privy Distance from nearest well------------------------------------•------------Distance from nearest building------------------------------------- <br /> Distance to nearest lot line---------------- ---------- <br /> 1 Remodeling and/or,repairing (describe):-----. � t�rl' -•--/"� <br /> ----••---•..................•--•-------------------•----------------•--------------- <br /> --•---------------------••--------------•------------------------ <br /> ---------------- •------•------------ \ <br /> ------------------------------•-----•----------•-------•----------« --•----- <br /> -----------•-------"-------------------------------- , <br /> - ----------- <br /> 1 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 reations of the San Joaquin Local Health District. <br /> 30 tocafii�on <br /> --- er an r Contract- ------------- ---------------- = - --...----- n d o�-�` _..(Signed} `BY� -- ----- -- -=- - -------- - ---(Title)--------•---------------------------------.(Plot plan, showing size of lotof system in relation to wells, buildings, etc., can be placed on reverse stile. <br /> ' FOR DEPARTMENT USE ONLY y <br /> APPLICATION ACCEPTED BY-A" ---.--- DATE----�-L.`�..'�LzJ--------------------------------- <br /> REVIEWEDBY------------------ ---------------=-------- ---------------•............ DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-------------":------------------------ <br /> -------------------------------------- DATE------------------------------------------------------------- <br /> AFterations and/or recommendations:------------------ ---------"------- ------------------------------------------------------- <br /> -------------"--••--=-----•---.......... <br /> --• •--------- :. -------•----•--••--------................... ------------------- •--••- <br /> -•-•-------•"------------------------- - - <br /> 3 '�---�r� -_- --------•----•- ---- --- - •--------------------------------------- <br /> ---• -------• ----•-----•------ ,C�'-{•,�i61� /f (�j �g <br /> 1 ------------------- ----------------------- <br /> FINALINSPECTION BY-------------------------- ----- Date---------------_---------- •----- ----------------------------------- <br /> +I+ SAN JOAQUIN LOCAL HEALTH DISTRICT Ll - <br /> 130 South American Street 1 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> q <br /> Stockton,California <br /> Lodi California Manteca,California Tracy,California <br /> E5 9 REVISED 8-59 2M 5-62 ATLAS <br />