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FOR OFFICE USE: <br /> ----------------------- ------------- <br /> APPLICATION FOR- SANITATION PERMIT Permit No. __ ......... <br /> F --------------------- --------------- - -------- (Complete-in Duplicate) <br /> Date Issued _ll--__ _,z/ <br /> .__-------------------- ------------....___.___..__..__. "� This Permit Expires 1 Year from Date Issued <br /> offly <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 /> I JOB ADDRESS AND.LOCATION-_e .- ` <br /> Owner's Name. �� - Phone----------------------------_ <br /> IAddress---------1 7 - ------------ --- -- ------------ - --------•----•------- <br /> Contractor's Name------ --- ----= �--- ---------- --- ---------- -------------------------------------------- Phone------ ------------.--------- <br /> Installation will serve: Residence [Apartment House ❑ _ Commercial,❑ Trailer Court E] Mofel ElOther ❑ <br /> Number of living units: __ f Number of bedrooms_ _ Number of baths __ Lot size ----- - --------_________ -- .___----_----______.__-_ <br /> Water Supply: Public system ❑ Community system ❑ Private �pth to Water Table - __ _ ft f <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-- ----- :--- --- I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> 4 TYPE OF INSTALLATION AND SPECIFICATIONS: h <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r / <br /> Septic XTnk: Distance from nearest well a._.---Distance from foundation----/-_b---------Material ------ .................... <br /> '?7 ` 9__,A�c�'Liquid depth-------- ---r ------- Capacity----r'2' <br /> No. of compartments.............._.-_-__._...Size_ `_-_'�� .._ . � <br /> 4 Disposal ield: Distance from nearest well....s Distance from foundation_._la-..--.-__..Distance to nearest lot line_--___-____. <br /> Number of lines.____ _��__...____�_-Length of�each line--.__.__f._�_v__'_._.Width of trench....�_�-__------. <br /> Type of filter material,-_-__._-'�_ -.:- Depth of filteF material 3-.-1._1_.`._.-_-.Total length_.__ - _. _.-.-_____.___-__. <br /> l <br /> See a it: Distance to nearest w�.7 -_- .._ _ Distance foundation__=__-lp .Di tante to nearest lot line__--_...-__-_ <br /> P <br /> Number of pits..- ._.____---_.'._.__Lining material_-___ _._.__ ___ ... Size: Diameter____----- -- - Depth____._.__S___---------------- <br /> t - <br /> Cesspool: Distance from nearest well -----------._.-Distance:from foundation------------- . Lining material-_._..._._.____._.-.-.-.-_ <br /> ❑ Size: Diameter__ r ;�' --- ----------------Depth- f-------- --- - - ------ ------Liquid Capacity._------------------------gals. <br /> Privy: Distance from nearest W'ell_z.-c-..- �`--- ---------------------- "_Distance from nearest building------------_--_-_____________..,_-...-. <br /> ❑ Distance to nearest lot line`f--------------- - ----------------------------------------------------------------- -------------------------------------------------- <br /> Remodeling and/or 'repairing (clescribe):_ ---- --------------------,- ----------------- -- -------------=-------------- -------------------------- -----------•---------------- <br /> - <br /> - -- ----- ----------••--------­­---------------------------------------------------------------------- -------------------f ------- <br /> I hereby certifaw e prepared this application and that the work will. be done in accordance with San Joaquin County <br /> ordinances, State lr les and regulations of the San Joaquin Local Health District. <br /> (5i nod ------ --- - ------ ----- or Contractor) <br /> 9 ) ------- �/{?BY:--------------- - • •-- -�--=�----- -- - -----.-(Plot plan, showing size oflot, location of system n relation of wells; buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> l ^/ <br /> APPLICATION ACCEPTED 8Y.- ----------------------------- --- - - ± DATE------------ <br /> --�- _--- ------�- ----.�9.7. <br /> -. -----------f----------------------------------- <br /> REVIEIIVEDBY-----�-�----------�------ -�----�--�-�---- -�_--�- -- - ----�-�-�-�- ---- --�- -- -- -- -----�-�--------------- ----- - <br /> BUILDINGPERMIT ISSUED------------ ----------------------------------------------- -------------------- DATE------------------------------------------------------------- <br /> Alterations'and/or recommendations------------------ -------- -----•-------------- -..--------------.----------------- ---------- --•-•----------------•---------------------- ---•----------.- <br /> 1 <br /> 1 <br /> . ••------------------ ------------------------------------------- ------------•----------- <br /> FINAL INSPECTION 13Y .. --- ------ --- Date /- ------------------------ ----------------------- ---------- <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 /> i- E.H.9 2M 1-07 Vanguard Press <br />