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FOR OFFICE USE:. <br /> ------------------- <br /> -------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...C__7�1 ._ <br /> ------------------ -------- ---------------------------- (Complete in Duplicate) <br /> Date Issue <br /> ---------------------------__------- This permit Expires 1 Year From Date Issued 0 2_5�0 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w k In r 'n e i <br /> This application is made in. compkance_�with Count Ordin nce No. 549 <br /> JOB ADDRESS A,A LOCAT O ---------- <br /> --- - <br /> __----- ^ -- ---'> ---- --ah!!r_- <br /> ( !�__. <br /> - - ---------------------------------------------- Phone------------------------------------ <br /> - --------- ----------- -- ---- -- �- <br /> Owner's Name----- <br /> Address , �. -- -- - <br /> Contractor's Name `' .-------------------------------------- ----------------------- -----. Phone.. <br /> Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/__ Number of bedrooms Number of baths 3--_ Lot size -_ - --------------------------__ <br /> Water Supply: Public system C1 Community system El Private Depth to Water Table vit/ft. <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--------------------l No New Construction: Yes [ErlNo ❑ FHA/VA: Yes [`}INo ❑ <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 wgl__ f�-_-Distance from f�ndati n__..r��-------.Material---(� �_ `� e - <br /> No. of compartments- - --------------------Sizer---- --.,_- _Liquid depth---------------------Capacity - -------- .- <br /> ----- <br /> Disposal Field: Distance from neares well... p __..Distance from foundation----f -----Distance to nearest lot line_- <br /> Number of lines_____ <br /> -----/__-- --._ Length of each line/490"------ ---------Width of trench.°.__----------------------------- <br /> Type of filter material f�['/_-_Depth of filter material_��-____-__--._Total lengf,h-�� ___ �. <br /> See it:� Distance to clearest well----------------------Distance from foundation-------------------Distance to nearest lot line--------------- NJ <br /> Number of pits------------- _.------Lining material----------------------Size: Diameter-----------------------Depth----------.---------------------_' <br /> Cesspool Distance from nearest well-----------------Distance from foundation-_ --------------_Lining material_--._-_ ___-_----.----_-_--_-_--_-- <br /> ❑ "Size: Diameter--------..--------------- -----------Deth-------------------------- -Liquid Capacity----------------------------gala. <br /> Privy: Distance from nearest well___________ -----------------------------------.-Distarce from nearest building_____.__.____ __'_-__--____'____.____. <br /> ❑ Distance fo nearest lot line----- --------------- ---------- --- -------- -------------------------------------- -------- <br /> x <br /> Remodeling and/or repairing (describe):------ :. <br /> ------------•-----------------------------------`--------------------------------------------- ----- ----- ------------------------------ <br /> -------------------------- ------- ---------------- -- -------------------•-••-------------------------------•----------------------------------------------:------------------------------------------------- <br /> �` <br /> I hereby certify that I have prepared this application and that the work will 6e done-in--accordance with San Joaquin County + <br /> ordinances, State laws, and rules and,regula ions of the San Joaquin Local Health District. <br /> a <br /> Aw <br /> .(Signed)----------------- ----- - ----- -- � --- - ----- -.. .------------�--- --- - --- --------�------- - - - -- - , --=_----( ontractor] <br /> r <br /> sY ----------------------------(rtlel ° ------- <br /> (Plot plan, showing size of lot, location of syste , n relation to wells, buildings, etc., can 6e placed on reverse side). { <br /> 'FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------------------- ----------- ----------------- --------------------------------- ----'DATE--------------------------- ---- -------------- ------------- <br /> REVIEWED BYDATE - - <br /> BUILDING PERMIT ISSUED =- _: '' ` % �D'ATE - <br /> Alterations and/or recommendations:---------..-._-._-.. . -- - –�°�""�""� <br /> ti. =--------------------------------------- <br /> -:;--` -- -- <br /> __._� _._._..__._r—. <br /> -------------------,,..--.-._...--_--_----..-._..---_---_....-,----_...._.---..-_-_----._=__.F `__.__.._____________._.__._._____.-._.....------------------------_-.-_-.....__._._..-.----------------- <br /> ---------------- <br /> l y <br /> -.-_ <br /> FINAL INSPECTION BY:. 't 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 /> F.P.Cq. t <br />