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` FOR OFFICE USE; <br /> -------------------------- <br /> ------------------- --------------- <br /> -------------------------__________________________________ ---- _.I'll---------._ APPLICATION FOR SANITATION PERMIT Permit No. .�1. <br /> t ------- - ------------------------------ ------ l (Complete-in Duplicate) <br />` -------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ------- � <br /> Application is hereby made-'to the San Joaquin Local Health District for a permit to construct and .install the work herein described. <br /> G This application-is-made,.in.xompliance with County Ordinance No. 549. 05 cj —p Z49 _ Z� <br /> I JOB ADDRESS AND L ATION_ ,�-- <br /> Owner's Name------ --- ---- ------ --- ------------------------ <br /> - ----- -------- hone <br /> � � P <br /> - - -- -------------------------------------- <br /> Address •••--_t . - 1• = <br /> Contractor's Name -- - --------------"-------- Phone..---.-----------------------------' � I� <br /> Installation will serve: Residence Fg�r-_Apartment ouse ❑ Commercial ❑ Trailer/Court E] Motel F] Other ❑ <br /> + <br /> Number of living•units: __/___ Number of bedrooms _ __ Number bat1,� "%___ Lot size _---.___._ ----------------------- � I <br /> Water Supply: Public system ❑ Community system 0 Private epth to Water Table ------ _ ft <br /> 1 <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................... ) 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.) = _ <br /> Septic Tank: Distance from nearest welL...---_ ______.-Distance from foundation-------------------Material --------------_-----------------------__________ <br /> ❑ No. of compartments-- ---------------------Size-------•-- --------- ------- ---Liquid depth.----- -- ------- -----..Capacity----------------------- <br /> Disposal Field: Distance from nearest well..---------------Distance from foundation---.----------------Distance to nearest lot line________-..._____ <br /> ❑ Number of iines.------------------------------Length of each line--------- -------------------Width of trench---------------••--------- ------- <br /> Type of filter material ____-__._ --------------Depth of filter material----.------------. _._Total length----_---.__________________-_------------" <br /> I , / s <br /> Seeps e Pit: Distance to-nearest well----10-V-"---_-_ s Distance from to nearest lot line...'..______ <br /> Number of pits--- Lining material...... ._15...!--- Size: Diameter----- . _` ..__Depth__ -S--'._.________.__ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation_________________ __Lining material-------.__-"___._._.._.___._.__..__. <br /> ❑ Size`: Diameter. ..--------- ----- ----------- ---Depth--.---------- --- ----------- -------------------- Liquid Capacity- -------------------------gals. <br /> Privy: Distance from nearest well_______________________________._ ------ ------Distance from nearest building----------------.-----__---""---_-."---,". <br /> ❑ Distance to nearest lot line --------------------------- - -------- --------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe :---------- ------------+----------------------------------�� - --------- --- <br /> ---------------- -- -ef�_ <br /> ------------------ ---------------------# { <br /> ----------------------------`---------------------- <br /> hereby certify the Y t <br /> ---------- --------------------------•---------------------- --------------------------- -------------------------- ----- -=---- -------------------- ------------------------------------------ - --------------- <br /> y y at I have prepared this application and that the work-will be done in accordance with San Joaquin County <br /> ordinances, Stat a s,:,and rules and regulations of the San Joaquin Local,.Health District. <br /> Si ned <br /> I = <br /> { 9 } F"- an r Contractor) <br /> By:----- --- --------- �"f -- - ----- - . -----------------._ _-_._._ (Title) <br /> - o frac ar <br /> `{Plot plan,,sho g size6flot, locatio� of system in r lation to wells, buildings, etc., can be placed on reverse side]. <br /> { # FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. -------- -------------- • <br /> ------------ <br /> REVIEWED BY _-------------'---- T t ---------`--_ DATE <br /> BUILDING PERMIT ISSUED-------- -- - ----------------------------------- ------"`"` =- ------------ ------ DATE <br /> Alterations and/or recommendations <br /> .� - <br /> --------------------------------- ----------------------- <br /> .......................... --- <br /> ---------- <br /> x' 1. , <br /> --------------------------------------------------------- a----------------------------------- <br /> { 1 � % <br /> -------------------•—------------ .:.-- ------------- -------- -- <br /> ----- ------------------------- ----- - ---- -- <br /> 60� <br /> ------------ .....-------- . -- - --- ....---' ._....--- --------- ------ --- -----------•---------- <br /> FINAL INSPECTICN BY:.__-_-_--__---- .--:_- . �- --_•--.,� 1 <br /> i <br /> nate- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Streel 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press ` <br />