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APPLICATION FOR SANITATION PERMIT Permit No. ..j-� _ _ <br /> (Complete in Duplicate) <br /> Date Issued <br /> This Permit Exj2ires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> J08 ADDRESS AND LOCATION. ----- - --------- -- <br /> JOB --'- ----------- - <br /> Owner's Name-------- ---------—---------------------•------------ -------------------- Phone-------------------------- <br /> a_ ------------------------------------ <br /> Address--------------- � - ----- -- ---- -- ----- -----•-----•-•-------------•------------------- <br /> - -•----•------------- <br /> Contractor's Name---;� 1 - ------ra` -------------•------ Phone----------------------------------- <br /> Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms _•-__ Number of baths I----- Lot size -•_____________________________ <br /> Water Supply: Public system ] Community system ❑ Private ❑ Depth to Water Table--------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam* Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No j* New Construction: Yes ❑ No/�p 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 lines-----------------------------------Length of each line-----------------------------.Width of french------------------------------------ <br /> Type of filter material_________________________Depth of filter material-----------------------Total length------------------------------___________ <br /> Seepage Pit: Distance to nearest well�i,r.----------Distance from foundation-_di...........Distance to nearest lot line__:S_.__------ <br /> _ <br /> Number of pits-----I-----__._____Lining materia*.f Size: Diameter-----'_f-��__.._._-Depth__�+1r--------------_------ <br /> _ <br /> Cesspool: Distance from nearest well--------------___Distance from foundation--------------------Lining material____._.________-___._____-____-_____. <br /> ❑ Size: Diameter--------------------------------------De 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 /> --------------------- -------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------ <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, Stafe I ws nd rules and r gulations of the San Joaquin Local Health District. <br /> (S:9n�-- s ----------- ------------ --------------------------------------------------------------------(Owner and/or Contractor) <br /> 13y--------------------••--------------------- -----------------------------------------(Title)--•--- ---------------------------------- ---- ---------------- <br /> ---------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> of FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- - , . �-�_ -------------------------------------------------------------- DATE_e —_,/,3—_(&,/------------------------------- <br /> REVIEWED <br /> _,/,3—_(./.------------------------------ <br /> REVIEWEDBY---------------------------- ------------------------------------•---------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------—-------------------------------------- DATE---------------------------------------------- -------------- <br /> Alterations and/or recommendations------------------------------------------------ ------------------------------------------------------------------------•------------------------------- <br /> -------------------------------•-- <br /> ------- •--------••------------•--- ------------------------------------------------------------- -------- ----------------------- <br /> ` ­- ."-- <br /> --•---------- ---•-------- - ------ � ------- <br /> ---•-•------- <br /> FINAL INSPECTION BY----------------------------------------------------- ------- -- Date_ .-------------------------- -------------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> ES-9-2M Revised S-'59 F.F.Co. <br /> IF <br />