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�`ti�`1yR APPLICATION FOR SANITATION PERMIT Permit No. .-I.Q--!_-/.- <br /> (Complete in Duplicate) Date Issued ��/-- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'nstall he work herein described. <br /> This application is made in compliance with County Ordinance No. 549. ` �. �� <br /> [ ...--.__.:.. ---- -------------- -- <br /> JOB ADDRESS AND Tl N_--I Z� - f <br /> ------ P <br /> hone �T-- <br /> Owner s Name-- $ <br /> ----- - - ------ <br /> 1 " - -------- ----•----------------------•-----•----- <br /> Address_�� ------ L � <br /> Phon <br /> Contractor's Name----- i- ---__.-----_ <br /> ---- ------- --------------------------------------- <br /> Installation will serve: Residen Apartment House El Commercial ❑ -- of size � <br /> Trailer ourt Mote <br /> Numb g l ❑ Other El <br /> of livin units: umber of bedrooms _------- Number of -atlie -_ '---- - --'�------� ��------- <br /> Water Supply: Public system ❑ Commuriity system ElPrivate Depth to Water Table40 _ ft. <br /> ❑ Y <br /> Character of soil to a depth of 3 ravel Sand Loam El Clay Loa -"'"Clay ❑ Adobe ardpan ❑ <br /> feet: ❑ G <br /> Previous Application Made: Yes No F1 New Construction: Yes El No FHA/VA: Yas El No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> o septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> S is Distance from nearest well-- Distance from found ation__-_^ _______- -Materia!__--------------------------------------------•- <br /> No. of compartments----- -----Size--------------------------------Liquid depth------------ -------------Capacity------------------ <br /> i <br /> r <br /> ' posal field: Distance from nearest welL.�a��-_--_.Distance from foundation___---.----._----_.Distance to nearest lot line__ _-- -_.__. <br /> ^' Number of lines----- ---- g �� <br /> 1 Length of each line----rQQ_._------_---_.Width of trench_. - --- <br /> Depth of filter material------ -�I Total length ------•-----__-- - <br /> �-. � Type of filter material-�t?�- � p � ------ <br /> pag Pik Distance to nearest well--�_Q�11--------Distance from foundation-----,,------.---..Distance to nearest lot <br /> �� , - <br /> Number of Ets__- g Size: Diameter-L _g -------De th___ <br /> - Linin material- --_-.- -__-_- - - p <br /> t <br /> Cesspool: Distance from nearest-fresf well---------------_Distance fro __o----- <br /> 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 /> ------------------------- <br /> -------•---------------- <br /> S. <br /> - - ----- --- -- -------- ------ ------L---------------.---------•----------- <br /> /�!�� <br /> Remodeling and/or repairing (describe------------ ---- ---- --------------- <br /> r <br /> -------- - - - ----------- -- - ----- <br /> /. = <br /> ---------------------------------------------------------------------:---------------------- -- <br /> -------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------•------------.---------------------------------------------------------------------------------------------•--------------- <br /> I he certify that I ha' <br /> iprepared this application and that the work will be done in accordance <br /> with San Joaquin Count <br /> ordinan 5, S e laws, and rul s and regula ' sof the San Jaa uin Local Health District. <br /> 1 � �.($wnvContractor) <br /> (Signed)_ - ----- --- <br /> g . ---- ------ ng <br /> (Plot plan, ing si a of lot, to a on of system in relation to s, uildin s, et , can be placed on reverse side). <br /> FOR DEPARTMENT USE ONL <br /> ------------- DATE--------- � -------------------- <br /> APPLICATION ACCEPTED BY- -- ---�''�,D-- ---------- ----------- --------------------------- �� � /` <br /> REVIEWED BY --= -- <br /> --------------------------------------------------- <br /> BUILDING PERMIT ISSUED-------'----------------------------------------------------------------------- <br /> DATE----------------------------------------- ------------------ <br /> Alterations and/or irecommend ations--------------------------------------------------------------------------------------------- <br /> ------•------------------_----------- ----------------------- <br /> -----------------------------------------------------•------------------------------•--------------------------------------------------------------------------------------------------------•--•------•------------------ <br /> --------------------------------- <br /> � D - '� -�. 1 N�/sPGrf r -1' <br /> --------------------------------------------- <br /> E- _H 1�Q =--------------a r------------------------------------------------------------- _--------------------- --------------•------------ <br /> t --•------------------------------------ <br /> FINAL INSPECTION-BY Date--------------------- --------•----------------------------------------•----- <br /> -- . . <br /> I SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California <br /> Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised-1.57 F.PCO. - <br />