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VUR OFFICE USE; ��-- <br /> -------------------------------------------------------- <br /> -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> " Date Issued.-------------•_--_-- <br /> ------------ ---- - : "This Permit Expires i 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 escribed. <br /> This application is made in compliance with County Ordinance No. 549. 0CP2 (,pv <br /> JOB ADDRESS AND LOCATION •7Q//I' _ •fkrc� .� ` `� `F <br /> ----------------- <br /> Owner's Name-------- <br /> ------- ,--•----••----------•------------------------------------------------ ------ Phone.............--------------------- <br /> Address------ily-/?- .......- <br /> �f <br /> Contractor's Name----- f / _-. - - <br /> --- -- - ---------- --- ------------- Phone-----._--_------------------------ <br /> Installation will serve: Residence ❑ Apartmen. House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths ........ Lot size <br /> �y ------------------------•- <br /> Water. Supply: Public system ❑ Community system ❑ Private Depth to Water Table _TD_ ft. <br /> Character of soil to a depth of 3 feet: Sand-E'Gravel ❑ Sandy Loam ❑ Clay Loam ❑: Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date________________----l No ffl- New Construction: Yes tf No ❑ FHA/VA: Yes ❑ No n- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> '(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sep Tan r Distance from nearest well____________ _`Diatance�fromfoundation:__'__:._ "Material_'.-_______:_______:____:;•_ -: -: 0� <br /> No. of compartments--------------------------Size--------------------------------Liquid de th--------------------------------------------- <br /> ---Capacity----------------------- <br /> DisField:. Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line______-...____.._ <br /> Number of lines--------- -------------------------Length of each line-----------------------_-----Width of trench.. <br /> Type of filter material-------------------------Depth of filter material-:---------------------Total length-----------------_------------------ <br /> ,1 <br /> Seepage Pit: Distance to nearest well-_/��_..........Distance from foundation...�4_..........Distance to nearest lot line__�� <br /> [ � Number of its___' Linin material- 6_�'_ P, <br /> P• ------ g ---.Size: Diameter-----�3-- -----.Depth-------�-`�-~------------------ <br /> Cesspool: Distance from nearest well--------------.-_Distance from foundation---------_----------Lining material--------------------- <br /> __..________- I <br /> ❑ Size: Diameter Depth. ----------Liquid Capacity--------•------------------gals I <br /> Privy:; Distance from nearest well-------------------------------------------------Distance from nearest building----_---------------------••---------- _ <br /> Y <br /> ❑ Distance to nearest lot line---- ---------------------------------------------------------------------------------- � j! <br /> Remodeling and/or repairing (describe):----------------------------- ._ <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 to lati s of the San Joaquin Local Health District. <br /> (Signed)--------------------------------- ----- ----------- -- ------- ----------------------------------------------(Owner and/or Contractor) <br /> ,. <br /> By:------i ----•--- --------- ----------------------------- ----------------------------------------(Title)-------------------------------------------- - ------------- <br /> -(Plot plan. showing-site=of-iot,rlocatiofi ofsystem-in'elation-to•wells,pbuildings,-etc.,-can-be placed on-reverse-side). ,. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. -------- ---- -- -----s----- DATE_.------- <br /> REVIEWED BY _..--------- DATE <br /> ------- ------- ----- ------------•--------------- <br /> BUIIDING PERMIT ISSUED ----••--•------------------------------- ----------- <br /> --------.- DATE------------------------- I <br /> Alterations and/or recommend ations:----------.---_--------------------------------------------- <br /> ------------ --------------------------------------------------------------- ---------------------------------------------------------------------•--- <br /> ---------- --------•----------------------------------- ------------------------------------------- <br /> -----------------------------------------------------------------•---•--------------•----------------------•-•---------- <br /> -------------- <br /> FINAL INSPECTION BY---- --- - - - - - - eE, !° -------._.--- Date----- -------- - ---- ! <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street' <br /> 124 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES-9 REVISED e•59 F.P.GC.SM&-SO <br />