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FOR OFFICE USE: <br /> - ------------- -- -- -------------- ---- ----------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> - -------------- ------ ------------------- <br /> ---- ---------------------- - ----------------. - (Complefe•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 /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-. yy��fc' r,`� -�. �� - '4� h y � ' <br /> Owner's Name------Jp------ Phone <br /> Address---------- ---/ �------- -�------------------------------- ---------- •- - _ ----------------------- <br /> Contractor's <br /> ..--------------- ---Contractor's Name-.--e";�1 &------------------------- ------------- ------------------- ------- ------------ - --------------------- ---•- Phone------------------------------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -- -.- Number of bedrooms _. - Number of baths A-.-- Lot size -- - -- -------.------------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -'2.J-'ft j <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobn8 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 /> • posal Field: Distance from nearest weh__S_A..`......Distance from foundation-A0......---..Distance to nearest lot)jne-Irl--------. <br /> Number of lines ---_�------- --------------------Length of each line-- -�4 .Width oftrench---�-y------------------------ \ <br /> Type of filter material '-------------_-Depth of filter material---- p-----------_Total length_____? -_----.-----.--_.--.----------_ <br /> �eepage Pit: Distance to nearest well-/-qP............Distance from foundation_Py©---------Distance to nearest lot line-r........... <br /> Number of pits.--L_--------.-.Lining material---14-..... Size: Diameter.-.. .4-._.-.-_--.Depth-.., _.__.-----. <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 /> - r------------------------ <br /> --------- <br /> l - - -- - - -------------------------------------------------------------- ---- <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, Sta laws, and rules and requiations of thee San Joaquin Local Health District. <br /> (Signed)---- -- - ---------- ------ ------------------- --------------------------------------- - --- -(Owner and/or Contractor) <br /> BY:- ------------------.------- ------------------------ - - - -�----------------- --- --------=--------------- <br /> ------(Title)---------------- ----- - - ---- - - ..-----.--------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse.side), ._ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY._. '�--�--�' -�---7 <br /> - ---- - --��- -------- -- ------------------------ ------ ------ DATE-- � - -- --- -------------------------i---- <br /> REVIEWEDBY------------------------- ------------------- ------------------ -------- - -------------------------------------------------- DATE----- -------------•---------------------------------------- <br /> BUILDINGPERMIT ISSUED-----•-• -- - ---------------------------------------- ---------------------------------------------- DATE--------- -------------------- ---- ------------------------- <br /> Alterations and/or recommendations:---------- ---------- -- <br /> --------------------------------------------------------------------------- ---------------------------------------­ <br /> ----- <br /> - - C ./�--------------------------- - - - <br /> ---------- -- -----------------•------ -----------�---------------------- -------------------- ---------------------------------------- ------------------------- ---- ------ -.-------------------------------- <br /> ------------------------- <br /> r <br /> FINAL INSPECTION BY:-.� �r .- ------- ---------- Date-_J_`..�.J-h .. -. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slotktort,California Lodi, California Manteca, California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />