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vn v1 ,ILL Vol-: <br /> --------------------------------------------------------- <br /> ________________________________..____-----__._ APPLICATION FOR SANITATION PERMIT Permit No. . ... ..�� <br /> (Complete in Duplicate) <br /> ------- ------ This Permit Ex fres 1 Year From Date Issued '° s Date Issued .._ <br /> __._.. {� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. <br /> This application is made in compliance ith County Ordinance No. 549. <br /> e /L�i�/ 1 <br /> JOB ADDRESS A D LOCATION .�ivN .- ....... / F.'GCJ t `--''�-' -t� br' - <br /> Owner's Name .......f 3. .4e..'- � Phone..__... 1 <br /> Address --- ---+----........... -----------------------------.......................................... ---•• --•-•-...1 <br /> ---------------------- <br /> Contractors Name ------------------------- ----------------------------------------.-.. Phone.................................. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer-Court ❑ Motel C] Other 0 <br /> Number of living units: .1---- Number of bedrooms _�K -. <br /> umber of baths . Y. Lot size ._ l <br /> ......... _........................... <br /> 0 <br /> Water Supply: Public system ❑ Community system ❑ Private bd Depth to Water Table 1_57 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---------------------J No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r <br /> Septiank: Distance from nearest well__, ....:Dish ce from foundation______b___.....Mdterial___________________�_►_...___. r-_............. <br /> No, of compartments____---------------------Size __ • __ r <br /> 5-----.---Liquid de th---- ... ---------Capacity.. <br /> Disposal Field: Distance from nearest well.- -- -.._Distance from found tion-__..0..._..___ Distance to nearest to ........... <br /> Number of lines•___....... Length of each linele,_�_,� Width of trench.-- {.________-•-_.-_-•__ <br /> Type of filter material. .l_. ( Depth of filter material..]..!?.*'_______._Total Iertgth_.- .- -C�____________________________ <br /> Seepage Pit: Distance to nearest well---------------------- from foundation....................Distance to nearest lot line................. <br /> ❑ Number of pits----------------------Lining material----------.------------Size: Diameter-----------••----------Depth-----------------..._..---------- <br /> Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material------------------------- <br /> ...-jgals. <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity--------------------------- <br /> _ ___._Distance from nearest building'__ _____________ <br /> Privy: Distance from nearest well-------------------------------•. •-•-❑ Distance to nearest lot line Remodeling and/or repairing (describe):--------------••-------------------------------------•••-•-•------------•-•-----------•---------------------•------•----•------- ------------- <br /> --••---•-------------------------------------------•---••---------------------------•-•---------------------- -------------------------------- ----------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. <br /> �,,�71"­_1V1 <br /> (Signed)..x... _- -- __ tea... .- ----- -- ------------------------------------------------•--------(Owner and/or Contractor) <br /> ' ----- -----------------•-•-•- -----------{Title)-----------------•-----------------•---- ---..... --------- <br /> (Plot plen, showing size of lot, location of cyst m in relation to walls, buildings, etc., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------------------------- r DATE---•---------- +------/--• --- <br /> REVIEWED BY - - - -------- }- -------------------------------•-•-•-------------- DATE.... . . __... <br /> BUILDING PERMIT ISSUED---------------------------------- ----- ----------------------•-•-•----------------- DATE-----......... <br /> Alterations and/or recommendations:----------- _ ------------•--••------------------------•--.-.--------------•----------- <br /> ------------------------------------------ <br /> ------------------------------------------------••---• =:J....._.. <br /> -------------------------------------------------------- I-••-------- ----•---•=-- ----- -.-.---------------••-----•--------------....-------------------.-_------------....------•----------••-----------------------•-•-- <br /> FINAL INSPECTION BY------------- -- ----------- ---------- Date---- ---------�l.. .. _ .-7�--------- <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 /> ES 9 REVISED 8-99 ZM 5-61 ATLAS <br />