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y <br /> f <br /> APPLICATION FOR`'SANITATION PERMIT Permit No. ... ............ <br /> "-_ <br /> - (Complete in Duplicafe) J fq <br /> Date Issued <br /> Application is°`hereby made to the San Joaqu'sn Local Health District fora ermit f <br /> ` This application.is made in compliance{with County Ordinance No. 549. p r °construct and install the work fierein�tlescribed. <br /> JOB ADDRESS AND LOC N.,-- <br /> Q. l` <br /> ---- <br /> Owner's Name_;-`��-�---- ---- � ---•"----- ----------------------- <br /> --- -------------------- - - ---- ----- Phone-• - F " . _ . -- ----------------- <br /> ------------- ------------------------------------------------------ <br /> ------------- - <br /> Contractor's Name —? � <br /> ------------------------------------------------------------ <br /> ----•- Phone_------•-•------------- •'�. <br /> Installation will serve: Residence j2-�__Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living`units: 1-_ Number of bedrooms _ <br /> Number of baths /--__ Lot size _ _O__X_�(-------- <br /> WaterSupply: Public system [ orrimuriity system ❑ Private [❑ -Depth to Wafter Table __�,9 ft_ * `4— <br /> l Character of soil to a depfh'of 3 feet:. Sand C] Gravel ❑ Sandy Loam ❑ Clay Loam El Clay El Adobe ardpan <br /> Previous Application Made: Yes <br /> ❑ No Ei'lNew Construction: Yes El Nom' <br /> [ 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 /> Sep 'c Tank: Distance from nearest well----------- Distance from foundation__._=_______--"____,Materia!______"_____-_"______";"""_"__-- <br /> No.�of compartments_--- ---- - Size_-----••"-- <br /> - Liquid depth--------------------------Capacity--------------- <br /> ---- <br /> sal Field: Distance from nearest well-" ' <br /> �_,Distgance from founds#ion____/Q___------- <br /> Distance to nearest lot line__ ---- <br /> ®� Number of lines____________ _ ____ _Len th of each .line___-" �" "_ _ ":_-Width of trench____gel <br /> 4 -;;-------------------- <br /> -----------of filter material_Cy ----___Depth of filter material-_--��--_-------Total length________t ' <br /> epage Pit: Distance to nearest well ,i - _Dis#ance from f ndationl��_ <br /> --- <br /> �, �u ___.Distance fo:nearest lot-line_.-�---- <br /> '; Number of pits.__--l__------`""-Lining Fnaferial-" /=_--Size: Diameter--- `� �'! <br /> A - ---- -----Depth <br /> -------• ----- <br /> Cess ool: <br /> p Distance from .nearest well________"______-_Distance from foundation--------------------Lining material__-____-"-_:__ <br /> ❑ Size: Diarneter------------------------ -----------=-Depth----------------------- -- -- - ---------Li Liquid Capacity ff .. <br /> - - - ------- 9 p Y- �-------- ----------------gals. �! <br /> Privy: Distance from nearest well -____-------------------------------------------'Distance from nearest building <br /> El Distance- o nearest I of ine_______"" <br /> Remodeling and/or repairing (describe)-------------------- <br /> W <br /> Y ' <br /> ------------------------------------•--------------------- <br /> r ----------------- ` <br /> -------•---------------------------•---- <br /> -------------------------------------------- i <br /> ------------------------------------------- <br /> -------------------•------•-------------------------------------------------------------r'-•---•------=•_---=---.-•--..--------•--------------- <br /> 1 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 ana regulations of the San Joaquin Local Health District. <br /> 1 <br /> (Signed)_ ` <br /> ----------------------------------- ------------------------------------------- <br /> Plot <br /> By------_--------------- ---_---- -------- Contract <br /> I _.. ------------------ (Tifile) �ra/ /L-- `------ <br /> Contractor) <br /> ( pan, showing size of lot, location of em in relafion to wells, buildings, etc., can be laced on reverse verse side): <br /> E FOR DEPARTMENT USE ONLY <br /> E <br /> APPLICATION ACCEPTED BY <br /> + --------- DAT f" <br /> REVIEWED $Y_ � - _ <br /> t-^� <br /> -----------_:---- = DATES '---------- --------- <br /> BUILDING PERMIT ISSUED---•--------------- ,. ,.• ��„ <br /> Alttee�ratiios and/or reconr>dations ':- r '=' ~ - = -i---------- DATE--- rv--•---------------- -` <br /> ------------ --------- <br /> rCaLr1 <br /> _ r---------------------------- <br /> FINAL INSPECTION, BY <br /> ----------------------- --Date--- ------- .' ` <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street �_ ' <br /> 300 West Oak SfFeet 4, 132 Sycamore Street 914 North "C" Street <br /> Stockton, California Lodi, California Manteca, California <br /> .. 'y`o, Treey, California <br /> ES-9-2M , Revised 1-57 F.RCO_ <br />