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FOR OFFICE USE: <br /> -------------------------- .............................. <br /> --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------------------------------- (Complete in Duplicate) <br /> -----------------------------------­­------------------ This Permit Expires I Year From Date Issued 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 /> with Coun Ordinance <br /> JOB ADDRESS AND LOCATION <br /> L(e..... : ............... .................... <br /> ..... .... .......�5 ........................................... ...... <br /> Owner's Name------ .... ... .......... ..........#-4-------- Ph no,-- <br /> Address <br /> Address <br /> ---- - ------------------------------ ------ ................................. <br /> ..................... ....... ....... <br /> --- -------------------------- <br /> ---- -- ----------------------- 0 .. <br /> Contractor's Name............9---- -- ------------- ......................................... Ph ................................ <br /> Installation will serve: Resiclencel� Apartment House F] Commercial F] Trailer Court C] Motel [] Other [] <br /> Number of living units: ....... Number of bedrooms ....L Number of baths ....L Lot size ... ..................... <br /> Water Supply: Public system [I Community system Private [] Depth to Water Table "20 ft. <br /> Character of soil to a depth of 3 feet: Sand rl Gravel [] Sandy Loam E] Clay Loam [3 Clay ❑ Adobe[] Hardpan 0 <br /> Previous Application Made: (if yes,date____________________) No E] New Construction: Yes E] No ❑ FHA/VA: Yes E] No [3 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pub[i se i mailable within 200 feet.) <br /> V ) .11# <br /> s ance from foundatio ) . <br /> Septi Tank: Distance from nearest well.. ..... ........ n......11.... . ..... ...... <br /> No. of compartments_.____-1�1-—----------Size... depth.......7.-. <br /> pi� 7 �apacity... <br /> Disposal Field: Distance from nearest weIl&_'1,'_�_ __J&sQnce from foundatiop....1-51- Distance to nearest lot <br /> Number of lines...........*70—---------------ALength of each line..._'740= ..0..Width of trench....2..44.Z�............... <br /> T-0 <br /> Y Type of filter material... - Depth of filter material....J. ..............Total length.......... ....................... <br /> . k-- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. <br /> 11 Number of pits......................Lining material-----------------------Size: Diameter.......................Depth................................. <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material....._......_........................ <br /> 1-1 Size: Diameter--------------------------------------Depth....................................................Liquid Capacity............................gals. <br /> Privy: Distance from nearest well-________ Distance from nearest building.............__.____ ..__............... <br /> 0 Distance to nearest lot line----------- <br /> --------------------- --- <br /> ------------- ------/----------------------------------------------------------*....................... <br /> Remodeling and/or repairing (describe):--------- ........... ........ ...f 3 <br /> ...... --- ............................................................................ <br /> ............................................................................................................................................................................................................................. <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 rgigulations of the San Joaquin Local Health District. <br /> (Signed)-t....... ...(7._TAj .. .......... .. ....... ........................................................................(Owner and/or Contractor) <br /> By:..................................................... ............................................................................(rifle)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE------------------... .. ................................. <br /> REVIEWED BY--------•----------•----•------------------------------•-------- F DATE--- Q... <br /> BUILDING PERMIT ISSUED------------------------------------------ D ATE........................................ ............. <br /> Alterations and/or recommendations:...........................;;;*----------------------*---------------------------------------------­­­­-------------------*---*----------------­------- <br /> ............................................................................................................................................................................................................................. <br /> ......................................................................... ........... ----------------------------.................................................................................................... <br /> ............................................................................................................................................................................................................................ <br /> ..............................------------ ......................... -- ---- --- ------------- ........................................................................................................................ <br /> FINAL INSPECTION BY:............ Date....__...,' <br /> 9 <br /> ............. <br /> ------------------------- ------- ............................................. <br /> SAN JOAQUIN LOCAL 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,California <br /> 98 9 REVISED 8-59 RM 5-61 ATLAS <br />