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FOR OFFICE USE: <br /> _ _ _________________________"- __._. APPLICATION FOR SANITATION PERMIT Permit No. __O ?_.f <br /> ----------------------------------------- --------------- (Complete in Duplicate) /Q, <br /> /,3/�.,/ <br /> ----------------------------------- --- ----------------- This Permit Expires 1 Year From Date Issued <br /> 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 ANDl LO� CATION__. 1 .� --------------------------- • -------...............................I-----..._..-------- <br /> Owner's Name_------W�� ----------------------•-------------------- Phone..................... -•------------ <br /> Address---•----- _ �'�7Z�1 <br /> ---- ---------- --------------------- <br /> Contractor's Name---------------- - - - Phone.. <br /> Installation will serve: Residence Ra,"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> i <br /> Number of living units: __.t!___ Number of bedrooms ._r�_ Number of baths I--- Lot size -----_------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table _,1K&P.4. <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 I;!� New Construction: Yes ❑ No 2— 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 /> P _Liquid depth---------- ---------------Capacity----------------------- <br /> �� No. of compartments <br /> Disposal Field: Distance from nearest well.-_---.._.Distance from foundation_ X49-------- to nearest lot line____ <br /> _ __--_-- <br /> Number of lines--------- _ <br /> :�____._._ __ .__._- g__Length of each line________ ; Width of trench___.2 _`________________________ <br /> Type of filter material_ ,C 'l� Depth of filter material._"e_!!---------Total length-----4f�............------I--- <br /> Seepage Pit: Distance to nearest Hell----------------------Distance from foundation--------------------Distance to nearest lot line_________________ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h_-------------------_.----------- <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----------------------------------------------------------------------------------------------------------------------------------------- O <br /> Remodeling and/or repairing (describe)------------------- 06_404_,W1--- ---- <br /> ------------••-----•------------------------•------•---•--------••---•-----•-------------•--------------•------...--------------------•--------------------------•---------------------- <br /> g. 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 re ulations of the San Joaquin Local Health District. <br /> (Signed)•---------------v '-k"?�;' U'i_-- - ---- mor Contractor) <br /> BY: ----------- ---(Title)-- �'�� =--------------- - <br /> ••--•-•---•----------- <br /> (Plot plan, showing size of lot, location o stem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___j­__ f�G_z <br /> --------------- DATE----- `� - /� <br /> --=-�} - - - � :�--^=--u---=------------------ <br /> REVIEWEDBY------------------------------ -----------------------------------------------------------•--------------._.. DATE--------•---•------------ ------------------•-------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------._...---•--•-----••------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:------------------------------------------------------------------------------------------------------------------------------------.-------------------------- <br /> --------------------- --------------------------------.----------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------•----------••--------------------------------------------------------------------------------------•----------------------------------- ------------•---------------------- <br /> ------------------------------------ ------ --------------•------------ --------------------- --------------------------------------------------•---•---------------------------------------- -----------------•------------ <br /> FINAL INSPECTION BY:--- J '"":: :� -------------------- Date------r� f�,,: ..� ------------------- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E6.9 REVISED 9.59 r.PX0.XM 6-69 <br />