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APPLICATION FOR SANITATION PERMIT Permit No. �8.__---,�.__a <br /> (Complete-in Duplicate) <br /> P <br /> if ___ _ ________________ ----------_____ ________________ 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 No. 549. <br /> t''JQB ADDRESS AND LOCATION - --' ----- ------ '' <br /> j6wner's Name------ ----- ------------------------------- ------------------------------- Phone----------------------------------- <br /> Address -----_---------- ------- ------- ------------••------•----- <br /> Contractor's Name---- / ---- ------ --- ---- --- 5 % �� L = -- ------ Phone_- --. /----.7i <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___ Number of bedrooms _ - Number of baths_4 Lot size --- _ 1 %------------------------ <br /> Water <br /> `__________________Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table-;5 ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ <br /> PrAious Application Made: (If yes,clate_................. 1 No ❑ New Construction: Yes ❑ No [P-"FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 240 feet.) ' <br /> ptic Tank: Distance from nearest well-----------------Distance from foundation--.___________--..Material -------------------- <br /> No. of compartments_ .__.___.___.__ _-.-.__Size_______________ __ Liquid de th_-.-_____ ------ __. Capacity <br /> Disposal Yield: Distance from nearest well tk!.-Distance from foundation__/G'_........Distance to nearest lot line_e 5 __ <br /> [elf Number of lines----- ------___.__ _-_-_____Length of each line__. ®-----_-- -------Width of trench. ^r--------------__________ <br /> Type of filter material-_�?�_ LiC/, .Depth of filter material.__ Total lengthG___________________.___.-_ <br /> 1 - <br /> Seepage Pit: Distance to nearest Distance f fou dation__ <br /> _._______.Distance to nearest lot line ��..____ <br /> Number of pits---I_- --------------- <br /> ------------Lining material_`_' ..Size: Dia meter_�__�,-f"..__Depth_._____ _______________ <br /> t v� � <br /> C Cesspool: Distance from nearest well ________________Distance from foundation___ --------- <br /> ---. ..Lining material----------------------------------- <br /> ED <br /> -------- - -- ------------------❑ Size: Diameter- .-I--------- ----- ------ -----Depth----•---------- ------------------------------------Liquid Capacity,-,.------------------------gals. J <br /> Privy: Distance from nearest well___-----------------------------..........-_______Distance from nearest building------. _.___________.- <br /> ❑ Distance to nearest lot line --------------------------------- - <br /> Remodeling and/or repairing (describe):- ------------------------ ---- ------------------------------------•------•------------------- <br /> --------------------------------------------------- --- <br /> ------------- ----------------- <br /> ------------------------------------- ------------------------ --------------------------------------------------------------------------------------------•--------------------------•------- -- <br /> ------------------------------------ ----------------------- - - <br /> - -- ----------- - - --- -- - - •----- - - - ------ -- - - - - <br /> I hereby certify that I have prepared this application-a nd that the work will be-done in accordance with San Joaquin County. <br /> ordinances, State laws, and rules andl regulations of the San Joaquin L al Hlth District. <br /> (Signed--------------- ------- --- ---------- ------ -------- -- - ---- ------ --- ---- --- - - -------------- ------ - `._-. Owner and/or Contractor] <br /> By:-------------- -- ------ - - - ----- ---- ------ ---------------- --:-----(Title <br /> (Plot plan, showing size of lot, location of sy m in relation to wells, buildings, etc., can be placed on reverse . <br /> side). <br /> I � s <br /> 7 <br /> d FOR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY-- ------ ------ DATE.:_. = <br /> y <br /> REVIEWED BY ------ -'-- ---------- DATE: = <br /> BUILDING PERMIT ISSUED_..._.-------------------------------------------- - ---- D - -::- <br /> -----'------------------ - --------- --------------- <br /> Alterations and/or recommendafions:_._.___ -- �— <br /> 1T <br /> / <br /> -----------------------------------------------­ - ----- ------------ --------------- --- -------------------------------- -------------- --------- ---------------------I---------------_-------------- <br /> ---- -------------------- - -------------------------------------------- ---- --------- <br /> ---------------------------- <br /> ----------------- --------- --------------- --------- --------------------------------- <br /> --------------- ...................­_ i ... <br /> FINAL INSPECTION BY: « # Date__.-.-.------------------------------- <br /> SAN .. <br /> ` <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> . i <br /> 1601 E.Hazelton Ave. '300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,caufornia I <br /> E.H.92M 1-67 Vanguard Press <br /> J <br />