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FOR OFFICE USE: <br /> �' - ----. APPLICATION FUR SANITATION PERMIT Permit No, ._.-��..... <br /> ------ --------• --- ----- ------ --- ----- --------- (Complete in Duplicate) <br /> Date Issued ... ..z���� <br /> ............ ... ........................................ This Permit Expires i Year From 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------------5 .3 �/ j -------------------------------------------------------------- -------------------•------- <br /> !AddrOwner's Name------------ ---- ------- <br /> Address----------------- <br /> ess-----•-----•-------•---•....................------------- t- --------------------------------------------------- <br /> Contractor'sS 6 <br /> Name------.... ------ --= It <br /> Installation will serve: Residence E` Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .---- Number of bedrooms -.4.-. Number of baths --/.... Lot size ------ o......?-.7..y------------------------- <br /> Water Supply: Public system E- 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: (If yes,date....................) No Zj-'�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 ----Distance from foundation.... Material---- Rc-d �o uC <br /> ®` p s�Jl� ----Liquid depth--------`Y................Capacity--- � <br /> No, of compartments �............ Size... - _... <br /> Disposal Field: Distance from nearest well../.Ya.a..c..Distance from foundation---/!-.�-........Distance to nearest lot line.-s.._.....-. <br /> © Number of lines.-_-----------------------------Length of each line----...-f.0--_------_.....Width of trench.....z-�...._.-..__�____----_ <br /> Type of filter material---/�F-F A_..----Depth of filter material.--- ......Total length..--.-... ------------- <br /> Seepage Pit: Distance to nearest well- a_k_g,-__Distance from foundation---Z-9 foundation---_/__-ca-........Distance to nearest lot line--.s----- -----._ W <br /> E} Number of pits-------/------------Linin material-----....- ---Size: Diameter----3 ----.-----.Depth---- ---Z-=------------------ � <br /> Cesspool: Distance from nearest well----------------n 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)----------------------------------------------------------------------------------------------------------------------------------- ------ ,r <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ------ <br /> (Signed) Owner and/or------------------ ---- - --- -/ f..------.. -------------- -------------- ------------------------- ( / Contractor) <br /> By:------------ --------- --------------------------------------------- ----------- ----------------- --------------------------(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----............. ---- ---- --- - -------------------------------------------------------- DATE-----------''� <br /> REVIEWEDBY------------------------- ..... ---- - - - - - - ---- --------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED--------•----------------------------- -------------------------------------- DATE--------------------------------------------- --------------- <br /> Alterations and/or rec m en anon :----------.- <br /> --------------------------------- --------- <br /> ---------------------------------------- .:; :-- -- �--!------------------------------------------------------------ <br /> FINAL INSPECTION BY---------------e -------------------------------------- Date------- , ./ = ...................... ------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:eltan Ave. 300 West Oak Street r 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.C C. r- <br />