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,'D <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ./ ._. .l... <br /> (Complete in Duplicate) �f / <br /> ka <br /> / _/-___--7Z <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 . 549 <br /> JOB ADDRESS AND <br /> L <br /> Owner's Name---- Phone <br /> � �=-�8.-. <br /> Address -------- -------- ................... ....--- ------------------------------------------- <br /> W 7 <br /> PhoneContractor's Name----- <br /> Installation will serve: Residence gro'A�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._ Number of bedrooms Number of baths ___ Lot size ----116W -------•--------------- <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table4l - <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gr-Hardpan ❑ <br /> Previous Application Made: Yes ❑ No (, New Construction: Yes ❑ No UR-­-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 /> S f' ank> Distance from nearest well_________________Distance from foundation--------------------Material__-_--_-_____-.___--------.._-_-__--------__.---. <br /> No. of compartments--------•-----------------Size-------------------------------Liquid dep;h--------------------------Capacity--- -------•----t <br /> i Field: (, Distance from nearest well._- --.-Distance from foundation__--____....Distance to nearest lot Vne____�__._._.. <br /> -k Number of lines____________'__ -Length of each line__--._./O_11---�-----Width of trench------r�_____---_ ------------ <br /> Type <br /> ____---__ <br /> T e of filter mat6r�l _ ----Depth of filter material_-____��_--___-Total length____.__--Q.____________�.`___ O <br /> Yp - - <br /> Seepage 't: Distance to nearest well Distance.;kom undation_�C.....----.Distance to nearest lot link-- `5 ---------- <br /> Number of pits_____/_--_.---_-_Lining material../_ ___ Diameter_­ <br /> 33 Diameter. 33_____..__Depth__. <br /> .2_,T'_/ �• <br /> Cesspool: Distance from nearest well-___---______--_Distance from foundation ___._:Lining material------------------------------------- <br /> ll, <br /> ❑ Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity------------- --------------gals. <br /> 1 <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-__.________-___-_----_--_--_____---____.. 1 <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------==--------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------------------------------------------------- <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, S a laws, and rules9d regulations of the an Joaquin Local Health District. <br /> (Signed)------ c--- 4------ -- ( ner and/or Contractor) <br /> f > <br /> By: <br /> -------------------------------------- - - <br /> ---------------------------- Tale <br /> (Plot plan, showing size of lot, location of system in relatio o ells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_______________________________ _ DATE______T-2: <br /> __ _ <br /> REVIEWEDBY - ------------•---------------------------------------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED----------------- • :-+--• - DATE------------------------------------- <br /> Alterations and/or recommendations------------------------------------------------ ------ > -= ---------------•------------------------------------ ----------------- <br /> ------------ <br /> ---------------- <br /> ------- <br /> ------------- <br /> -----------------------------. - ' l�; (� _ , = M � �l.Jl' �l <br /> �lJ 1 <br /> ^ �^-� <br /> ----------•---------------- f------------ ----------------=---_' _---------------- -- -----•-•----------------------------- --- ---- <br /> ------------- ------------------------------ -------------------------------------------------------------•---------------------•------------••-•--------•------------------•----------------•----------------- <br /> C <br /> FINALINSPECTION BY:.. ---------------------- -------- ------------- Date----------------------------------- ----------- -------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Reri5ed V59 F,P.Co. <br />