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FOR OFFICE USE.. <br /> -------------------- ----- ----------- --------------- - 9q� <br /> APPLICATION FOR SANITATION PERMIT Permit No. _ a.-:3_!_ <br /> _ __ (Complete-in Duplicate) r <br /> Date Issued <br /> ----------------------------- This Permit Expires 1 Year From Date Issued <br /> 1w <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constru t and mlall the work herein described. i <br /> This application is made in compliance with County Ordinance No. 549. <br /> D Lo ATIo _ a__- -- -••-- -- -- <br /> JOB ADDRESS A ��ff -------- ----------------- ------------ ---------- -- <br /> Phone----------------------------------- <br /> Owner s Na e_-_.-�l/a.�e_. - - - --••---------------- <br /> -------------------------------------------------------------- <br /> Address -- -- ------ r 4 <br /> Contractor's Name----.. ... ------------------------ ----- ----- ------------------------ ----------------•--- Phone ..._.-------•-•------ <br /> Installation will serve: Residence I!! Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J___ Number of bedrooms 1- 4Number baths -_�':_ Lot size __ .__ ___----------- -- <br /> Water Supply: Public system El Community system ❑.M Private Depth to Water.Table.------ - ft I { <br /> t <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_-_-------.__..._ I No ❑ New Construction: Yes ❑ • No ❑ FHA/VA: Yes ❑' No ❑ <br /> TYPE OF INSTALLATIONAND SPECIFICATIONS: I <br /> (No septic tank or cesspool permitted if public sewer is available within 204 feet.) <br /> Septic Tank: Distance from nearest well-------------. --Distance from foundation--------------------Material ------------- ------------------------ <br /> ------------- <br /> __--_-----__._.__-_-.._ <br /> ❑ No. of compartments-------------------------Size------ ti:_r:Liquid depth i ........Capacity----------------------- <br /> .f <br /> Disposal Field: Distance from nearest well.----- -----Distance from foundat.ion__--'-_.r..____.__.Distance to nearest lot line___._____._-__ <br /> ❑ Number of lines.----------------------------------Length of each line--------__---------r_Width,.of_trench-._.__--------------------------•-- <br /> Type of filter material._----------------------Depth of-filte�material-�""_._------.._.--_Total length----__!_..___--_______-----------_--.----� <br /> Seepa it: Distance to nearest well-._.faa--_____Distance'from foundation__r�'_-`______.Distance to nearest,lot line---------------- <br /> Number <br /> �-- <br /> I S ". Depth- S <br /> Number of pits... .... ____.._.-_-Lining material---___._,R._° Size: Diameter._.___ ..__ <br /> Cesspool: Distance from nearest well -_ --____._____Distance' from foundation.__`-...-...-_-_ ..Lining material_..:_r'______________________________.� <br /> ❑ Size: Diameter. .. - = ---- ---..'Depth__' -------------------- <br /> - --------- -------- ------Liquid Capacity--------------- -------------gals. <br /> l Privy: Distance from nearest well.......------------------------------------------Distance from nearest building______..__!___..--._-______----._.._._- <br /> ❑ Distance to nearest lot line -------------_- ------ ------------------------------------ ------------------------------------ ---=----------- --------- <br /> Remodeling and/or repairing (describe)------------------ ----------=------ —-------------------------- ----------------------------r---------------*----------------------------- <br /> � <br /> t <br /> - <br /> --- -•-•-- ---•--------------------------•-------------------------- ---•-----------------------------------------------• ---------------------- <br /> i <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 /> I ordinances, State s, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------------( -�_ -------D.... .. --------- - ---- - ----------------- - - ----------------------- ----- ------------------- -------------(sand/or Contractor) <br /> •(Title)_.- -- } <br /> (Plot plan, showing.size of lot, location o system i relation to wells, buildin s, etc., can be laced on reverse side. r <br /> ( FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ------ -------------------------------------------- DATE 1 �r-'- ---,------------------ <br /> REVIEWED BY-------------------------- ------------------------------------------------------------------ DATE------------------------- ------_ •----------------------- <br /> I <br /> BUILDING PERMIT ISSUED------- -- ----- -------------- ----------------------------------•------- ----------------- <br /> DATE---------------------------- ------.---- -------------- <br /> ---------------------------- <br /> Alterations <br /> ------------Alterations and/or recommendations:-------------- -------- ------- ------•------- -------- -----------------------------------------------------------------=--- <br /> ---------------------------------- --------------- ----------------- ---- ---------------------- -----•-------------------------------- - <br /> -- ---------------------------------------------------------- ----------- <br /> I -- •----------------- - - - -------------- --------------------------------------------- ---------------------------------------------- --------- "--- ---------------------------- <br /> --------- ­---------------- ------------------------- -- -------------------------- ---- ----- -----------,--------- ---------------- <br /> /*�, < - 3- '7 <br /> _ %4 <br /> FINAL INSPECTION BY:---- €r ---------- Date/_W.-.- � - --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I 1601 E.Maselton Ave. 300 West Oak Street 124,Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi. California Mantecar California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />