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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> --------------------------------------------_-_-.__.-- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------- ------ -- -- --- ------ ----------- (Complete-in Duplicate) pp <br /> Date issued <br /> _______________________ ------------------------------ This Permit Expires 1 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 <br /> l Ordinance No. 549. _ <br /> JOB ADDRESS AND LOCATION-----____-. ISC,�V2Q ft,---gqf��4us ----------------------------------------- <br /> Owner's Name---------------------------------- (4.�ts�` -------------------------------------------- ------- ---------- Phone--Q3-S------- <br /> I-1Z 1A <br /> Address-------------------------------------- --A-------- -------- <br /> Contractor's Name--------------------------------------P&M,-----w4v/ °�2'►�� ''--9leC�C,,A--------------------- Phone.-- �- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s <br /> Number of living units: __._____ Number of bedrooms -------- Number of baths ________ Lot size ____________________________________________________________ <br /> Water Supply: Public system ❑ 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 ❑ 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.) L T <br /> t <br /> Septic,,Tank! Distance from nearest well-...- -----Distance torn <br /> _ foundation-.._._ ..__..,Material � �_ ______ <br /> ______ <br /> _ _ p -No. of compartments------______ ________ _- Size----- -------------Liquid depth------y----------- _. Caacity-- - ------- <br /> Di s <br /> ------Dis <br /> i <br /> field: Distance from nearest we€l---&.Q.......Distance from foundation---/5-----------Distance to nearest lost, line___11__._... <br /> Number of lines------------- "- Length of each line----------$0_------------ Width of trench------s ..------------------------ <br /> Type of filter mafienal_. ___ _..ILD_�...__Depth of filter material......1__�____.__._Total length......... - - -------------------- <br /> Seepage Pit: Distance to nearest well----- ----------------Distance from foundation--------------------Distance to nearest lot line-_.__--.______-._ <br /> ❑ Number of pits----------------------Lining material--------.--------------Size: Diameter------------------------Depth--------------.-------------.---- <br /> Cesspool: Distarce from nearest well_________________Distance from foundation--------------------Lining material_____.....__..____.___.._.____..___ <br /> _D.µ_. w _ _Size¢Diameter4 = Depth = _:: Liquid Capacity - gals. <br /> - <br /> Privy: Distance from nearest well._..___.______________________________----------Distance from nearest buildirg___.__._-._________________.-__-.__.._. <br /> ❑ Distance to nearest lot line----------------------------------------I----------------------------------------- --------------------------------------------------------- J <br /> Remodeling and/or repairing (clescribe)------------------------------------------ --------------------:------------------------- - ----•------------------------------------------------------- <br /> I,• <br /> ------------------------------------------------------------------------------------------------------------•----------------- --------- • x------- ----------------------------------------------------------- <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 /> ------ ------- Owner and/or Contractor <br /> (Signed)---------------------- ( / ) <br /> _ <br /> B � -------- <br /> IT, <br /> --- <br /> (Plot plan, showing size of lot, location of sys+ in relation to wells, buildings, etc., can be placed on reverse side). <br /> 1 � <br /> i <br /> FOR DEPARTMENT USE ONLY q� <br /> APPLICATION ACCEPTED BY--- -- = DATE __!_-R4-67 <br /> REVIEWEDBY- --- - ----- ------------ ---- ----------- ------ -- -------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED------------- --------------­­--------------------------------------------------------------------- DATE------------------------------ <br /> Alterations and/or recommendations:------------ ------------------------------------------------------------------------------•----------•-------------------------------------------- <br /> --------------------------------------------------------------------------------------------------- -------------------------- ------ r---- ------------------------ ------------------ -------------------------------- <br /> FINAL INSPECTION BY'_-__ __ _ --- Date -------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> 'Lodi,California Manteca,California Tracy,California <br /> .s- <br />