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APPLICATION FOR'_SANITATION No.SANITATION PERMIT Per 'f No. <br /> ------------------------------------- (Complete in.„Vuplicate <br /> ------------------------------------------------------- This Permit Expire 'l Year From Lite Issued Da <br /> Application is hereby made to the San Joaquin Local Health listri;m'or a it to construct and inst#”t9e work h 141 described. <br /> This application is made in compliance with Co inty OrdinaAe.No. 549 <br /> JOB ADDRESS AND LOCATION_ ---------------------------------2q <br /> .......... --- --------- -------------------- <br /> Owner's Name--- ✓'" ------- ------ Phone---------------- <br /> Address -------------------- <br /> ...-I.X4------------------------------------------------------------------------------------------------------ <br /> ...................... <br /> Contractor's Name---- ---------------------------------------- - - - -----------------------------------------------------------------------.. Phone.------.-----•-•--------•-------- <br /> Installation will serve: Residence 9 Apartment House E] Commercial E] Trailer Court [] Motel [] Other [] <br /> Number of living units: .1---- Number of bedrooms __1_-- Number of baths -------- Lot size -----------Id _______________________ <br /> Water Supply: Public system 0 Community system 9 Private 0 Depth to Water Table 1p ft. <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel [] Sandy Loam E] Clay Loam Clay [-] Adobe E] Hardpan E] <br /> Previous Application Made: (If yes,date-----------------.--) No F" New Construction: Yes R'*-'No E] FHA/VA: Yes E] No E] <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---/�""041)istance rom foundation-----/P---------Material------ ------ <br /> -------------- J 11� I /I <br /> No. of compartments_---------V—---------Size-TWA---)(�_61__Liquid depth-------4V------ ----Capacity__.,/_.1__e_7v--------- <br /> Disposal Field: Distance from nearest well_/&40_/4_Distance from foundation-----.10_�-- <br /> - --Distance to nearest lot ling--- ---Ir <br /> ------- <br /> Number of lines-------------- Length of each line_-----___-____.-----_-------Width of trench--_-4_1�,* <br /> Type of filter material_/,A-__.- -�__Arth of filter material------141-----------Total length-------4? <br /> Seepage Pit: Distance to nearest well---------------------- ittance from foundation----_--------------Distance to nearest lot line----------------- <br /> 0 Number of pits-----------------------Lining material-----------------------Size: Diameter-----__---_---__.-__-Depth-_-_..__---__-__.__-____--._ <br /> Cesspool: <br /> epth--.---.----------------------- <br /> Cesspool: Distance from nearest well-----------------Qistance from foundation--------------------Lining material------------------------------------- <br /> 0 Size: Diameter--------------------------------------Depth------------------------------------------- --------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well---------- --------------------___-------------Distance from nearest building---__-----------------------------_-._. <br /> ❑ <br /> uilding----------------------------------------- <br /> F-1 Distance to nearest lot line-------- ------------------- ------------------------------------------ ------------------------------------------------------------------ <br /> Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------- ------------------------------------------------------------------- <br /> --­----------�4--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------_._---------------- <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 San Joaquin Local Health District. .I <br /> (Signed)----------------------------W ------- - -------------------- ---------------------------------- -------(Owner and/or Contractor) <br /> By----- ----- -------------------- --- ---- ---------------------------------------------------------------------ffitH_ --------------------------- <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 /> .APPLICATION ACCEPTED BY-------------- ------------------------ ---------------------------------------------------------- DATE-------------------------- --------------------------------- <br /> REVIEWEDBY-------------------------- --------------------------------------- ----------- ------------------------------------------- DATE------------_------_----------------- ------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE----------------------- ----------------------------------- <br /> Alterations and/or recommendations::--------------------------- ----------------- ------------------------------------------------------------------------------------------------ --------------- <br /> ---------------------------------------- ------- .................... ------- ---------------"I-----------------------------------------------------------------------------........................................... <br /> ---------------- ------------------------------- ------ ------------ ------ ------------ ------------------------------------------------------------------------------------------ ------------------------ <br /> ----------------- --------- ---------------------------------- -----------------­­-----•----------_-_- ------------ --------------------------------------------------------------------------------------------- <br /> ------------------------------ ---------------------- --------------------------------------- --------------------------I------ ------------------------------------------------- ........ <br /> FINAL INSPECTION BY:.. -------- ----- - Date..... - <br /> k- <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 /> F.P.C C. <br />