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FOR OFFI E USE: - <br /> ------------------------------------------- ---- -------- <br /> APPLICATION FOR -SANITATION PERMIT Permit No. ..1-� . <br /> ---------------- ---------------------w----------------7_.-, .. (Complete in Duplicate) b <br /> p• m Date Issued Date Issued <br /> _. This Permit Ex� rtes 1 Year Fro .- <br /> Application is hereby made to the San-Joaquin Local Health District for a permit to construct and install the work herein described. ` <br /> This application is made in compliance with County Ordinance No. 549. <br /> 1 <br /> *31 <br /> JOB ADDRESS AND CATION `-��T Y�__.__ __---- ---------------------•--------------------------------------------------- �t <br /> n _ <br /> Owner's Name fY.l - == -------------------- ---- Phone--------------­----------- ------ i <br /> - <br /> Address { ----------- ----- -----•-------------- <br /> Contractor's Name---- ----•--•----- - --•.__._ � ~c Phone <br /> Installation will serve: Residence [7 Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:.---,/-'- Number of bedrooms --- Number of baths �,)-._ Lot size .1!�:T---- ! z --------------------- <br /> Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [`❑ Clay ❑ Adobe Q--Hardpan ❑ <br /> Previous Application Made: (if yes,date..------------------) No New Construction: Yes 2- n o ❑ PHA/VA: Yes � ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sepc T.nk: Distance from nearest well --------Distance from foundation___` ------- <br /> t' . rl <br /> Iv�a�ial_. �r <br /> No- of compartments___--_________________ _ q P _-Capacity.l .___ <br /> : r <br /> - Size {--��r-r--'��_.__Li uid de th--- ----------------- - <br /> Disposal field: Distance from nearest well------`------Distance from foundation__ __ � _.__Distance to nearest lot line __________ <br /> Length of each line__ __�. _.�S Width of trench._,c� l <br /> Number of lines----�- ------------ 9 .i <br /> Type of filter material____ -_.Y_r�k5epth of filter material-_ ______.__-_Total length___._ ------------------------ <br /> See peg it: Distance to nearest well.__.-__Distance from foundation___ _____.Distance to nearest loft line._._______ <br /> t i <br /> Number of pits---------- ------Lining <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 <br /> --__---__--_- ____:_______________.._.Distance to nearest lot line-------------------------------------------- -------------------•----------------------------------------------------------- -------------- <br /> '-� - <br /> Remodeling and/or repairing (describe):__..__ -________ __ _ ____ -----__- <br /> -------------------------------------------------------------------------- --------------------------------------------------------- ---- --------------------- --- <br /> --------•-----------------------•• -------------------------------------------------••-----•---•--•----------------•-------------------------------------------- -•---•-------------------------------- <br /> ------------------ -------- ---------------------------=------- ------------------------------------------------------- <br /> I hereby certify that I have pr a d this application and that the work will be done'in accordance with San Joaquin County <br /> ordinances, State laws an ules eg lations of the San Joaquin Local Health District. <br /> } r <br /> (Signed)----.______.______ ___ _----(Owner and/or Contractor) <br /> or <br /> By---t ------------ --------- { --- ---- ---------r--- - ---------------(Title) �reversesi <br /> ...---- ---- <br /> (Plot plan, showing size of ocation of,system in relation ells, buildings, etc., can be"placed on <br /> F R RT T USE O LY <br /> ,� -- - ------- DATE <br /> APPLICATION ACCEPTED BY__. __ ___ ,__ .._ __ .... <br /> REVIEWEDBY------------------------------------- - ------- . - -------- DATE. <br /> BUILDING PERMIT ISSUED._:. '" = ---- ------- --------=-------- -" TE------------------- <br /> y� ------------------------------------ <br /> ' 14 <br /> A{cera#ions and/or recommendations: 1� v -•-••----------------•--------•-••------------------------------- <br /> ---•-- <br /> ------------------------------------------------------------------------------- <br /> -------------------------------------- - ---•------ ----- -------------- <br /> -------------------- ------ ----------------------- ----------------------- - ---•----------- -­----------------- <br /> -------- <br /> --•-------------• . <br /> --- ------ f <br /> 1 .1 : <br /> /111 <br /> FINALINSPECTI BY:-- ----- ---- -- - -- - -- ­- - -------- ---- te--------------- -------------- -------- <br /> SAN JOA UIN LOCAL ALTH 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 /> E5 9 REWS&C 8-59 3M 3-'63 r'.P.00. _ <br /> t <br />