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FOR 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 Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliarycP i �ur�ty,C�r <br /> JOB ADDRESS AND LOCATION! ° T y �lsr °� ------1�"©---------------------------------- <br /> W --- _. <br /> Phone- <br /> Owner's Name Phone__ ass'-_e� 9 <br /> ------------- ------------------------------------------------------------------------- <br /> Address---- �� 2- c� '� etC <br /> Contractor's Name----aW!Jf—�.-FL ........-•------------------------------------------------------------------------------------------------ Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> a <br /> Number of living units: ,--__ Number of bedrooms S-_ Number of baths I---- Lot size _------------------_..--_-.----_-.___---__------.-_._-__-- <br /> Water Supply: Public system FT'Community system ❑ Private ❑ Depth to Water Table/-4?- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[j Hardpan [] I <br /> Previous Application Made: (If yes,date_....... ---.------) No New Construction: Yes ❑ No �HA/VA: Yes ❑ No <br /> TYPE FOF INSTALLATION AND SPECIFICATIONS: T <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest <br /> ❑ well ------Distance Distanqce--f.`rjom_f_andt_ion--------------__.-Materl <br /> -----_.________.__._____..____._____....________. <br /> � ------- <br /> Capacity_f ..__.No. of compartments----- - <br /> _ ------- Size--- _-- � Liquid depth - __ <br /> Disol field: Distance from nearest well---tel D_ Distance from foundation--/ ----------Distance to nearest lot line----,>'—_._------ <br /> Number of lines-----____/_.__________ -----Length of each lin e------�d__ Width of trench.--_-4 ,__`� <br /> 4r--------- a ---- --- -------- <br /> Type of filter material -------------- -------Depth of filter material--_If-- --.--.Total length------S- _____-------__---_--------.- � <br /> Seepage Pit: Distance to nearest ell____________________Distance from foundation--------------------Distance to nearest lot line..-----------_.__ �f <br /> ❑ Number of pits------------------ ---Lining material----- .................Size: Diameter------------------ ----Depth--------------------------------- <br /> Cesspool: Distance from nearest weld-----------------Distance from foundation-------------------.Lining material---.-_--------.----.._-..-__---.__-_ n <br /> ❑ Size: Diameter----- --------------- ----------------Depth----------------------------- ----- ----------------Liquid Capacity----------------------------gals- <br /> Privy- Distance from nearest well------------------------------------------------- from nearest building___._._-.__-..--------------_-.-.-_..._. <br /> ❑ Distance to nearest lot line-------------------- --- - ------ ------------------- -------------------------- --------------------------------- ----- <br /> j �- L <br /> Remod4ng and/or repairing (describe)------ ------- ^w- -----------------------•------------- ------------ <br /> ------------------•--------•-•-------------------------------- --------------------------------------------------------------------------------------------------------------------------••------------------------------ <br /> a <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 the San Joaquin Local Health District. <br /> (Signed)----------------------------------- _: .-- -------------------------------------------------------------------------- - --------------_.----(Owner. and/or Contractor) <br /> By--------------------•----------------------------------------------------------------------------------------------------------------(Title)---------------------------------------- --- --- -------------- <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMEN E ONLY <br /> APPLICATION ACCEPTED BY--------- `► ----------------------------------------------------------- DATE--------- �� <br /> REVIEWEDBY------------------------------- ----------- ---- --------- -- DATE--.-- ---------------------------------------------- <br /> BUILDING <br /> ------------- - --------- <br /> BUILDINGPERMIT ISSUED-- --------------------------------------------------------------------------------------. DATE-----_----------------------- -------------- --------------- <br /> Alterationsand/or recommendations:---------------------- -------------- - ------ -----------------------------------------------------------------------------•-------------------------------- <br /> --------------------------------- -- ------ ------------ -- --------- - ----------------------------------------------------------------------------------------------------•----------------------------------------------- <br /> --- ---- ---- <br /> FINAL INSPEC 6 -- - ------ - ----- ----- Date----.-----_--------- '_`-. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> w <br /> F.P.CO. <br />