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rUK U"K-1: USE; <br /> ----•-------------------------------------•-----------"-- <br /> -------------- --------- ----- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ...l...�� <br /> i (Complete in Duplicate) L/ <br /> ------------I.....­ i Date Issued Y/Sf✓ ?/ <br /> --"--- This Permit Expires 1 Year From Date Issued 7 �� <br /> t Application is hereby made to the San Joaquin Local Health District for a permit to co install the work herein describe <br /> es ribed <br /> This application is made`in compliande,with�County Ordinance No. 549. <br /> JOB ApDRESS AND LOCATI074 <br /> Owner's Name... ate.--------•---• ................. - ----•-------------------- Phone---------•--------- <br /> Address...........Rw._.... ........ / <br /> Contractor's Name...- _•--_- •--••__-_- <br /> - ---------- <br /> _ -------------•-----.-.----•--•-------------------------------------------------------- Phone................----- ---- <br /> Installation will serve: Residence ❑ Apartment.House ❑ Commercial ❑ Trailer jigot JP Motel ❑ Other ❑ <br /> I" Number of baths _--.... Loft size --- <br /> Number;of living units: ...__ Number of bedrooms �- <br /> Water Supply: Public system ❑ Community system ❑ Private. ] Depth to Water Table 7r ft. <br /> F <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam W Clay ❑ Adobe❑ Hardpan' <br /> Previous Application Mede: If es,date ----------------- �►] � ❑ N ❑ ❑ <br /> PP ( Y 1 No New Construction: Yes No FHA A: Yes No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank•or_.cesspool pegmiffed if public sewer is-available within 200 feet.) " <br /> Septic Tank: Distance from nearest well `a------Dista ce from foundation_1_.d-'_.........Material. ------------------------------------------- <br /> No. <br /> p -- <br /> Dis <br /> Disposal Field: Distance fromrneares W ------- Size-_ .{'-3t-` ----------Liquid depth._---; -..-__. <br /> ---------Capacity-., �---...... <br /> p SII* '-. ,-Distance from foundation---LA----- ---.Distance to nearest lot line___4`�._...... <br /> Number of lines=` �---:-�_�- - -_- g ! <br /> � Length of each line_`.-- .---1-iL-Width of trench..A--V.-`........................ `� <br /> Type of filter rnateria�� .��__ �^ ` <br /> _-f'?�,---_Depth of filter material----)Ay-------_--Total length...... <br /> Seepage Pit: Distance to nearest well_---.- ---'----_Distance from foundation....................Distance to nearest lot line------.--------- <br /> ❑ Number of pits.---_----------------Lin g material-----------------------Size: Diameter_-------------•-------Dept h----------------.-••-- ----_- <br /> Cesspool: Distance from nearest well------------_-.._Distance from foundation--------------------Lining material------------------------------ 1 <br /> ❑ Size: Diameter•-------•------------------ t------Depth -';----------------•------- --------Liquid Capacity..................... <br /> gals. , <br /> Privy: Distance from nearest well------ ----------------_ --.--.-Distance from nearest building <br /> ElDistance to nearest lot line------------------------------ - <br /> Remodeling and/or repairing (describe]:-------.-_------------------__- k <br /> .............. -----•------- --• <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 /> (Si ned " <br /> g ) ..._... -.(Owner and/or Contractor) <br /> BY:--------•---_...............---------------••---------"-----....-•------------------------------------•----------------•---_--Irt <br /> (Plot plan, showing size of lot, locatI n'of sysfem in relation to wells, buildings, etc., can be placed on reverse side). <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY./ ----------------------------------------------------------------------------------------------------------------------- <br /> DATE------Y_- ... =----•-�------------;- - <br /> REVIEWED BY-----------------•-----------------•--------- ------------- ••--------- DATE-------.._.. --- ----------------------------- <br /> BUILDING PERMIT ISSUED-.., --- � •---------- DATE. Q <br /> Alterations and/or recommendations--------------------- <br /> --------------------------------------------------------------------•---------------••---------------------------•------------••-•- o <br /> -•-------------•--•----------------------------...------..--...---•----• ----------------••--------------------------------------------------------------------------------------------------------------------------- -------(, <br /> ------------•--------------------••-•- yr <br /> •-••--------- -•--------- ------------------------------------•---------------••--•--------------• ................ •----------------------------•----- <br /> ----------------------•-.-••-•.....-..--.•--- .... -----•- ---------------------------------------------------- ------------------------------------ ........... <br /> ---------- ---- G -� ... <br /> I <br /> FINAL INSPECTION .BY:.164 ,� --------- Date '1:G <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 Traiy,California <br /> E6 9 REVISED 8-99 8M 3•E1 ATLAS <br /> y <br /> 'I <br />