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I + <br /> APPLICATION FOR SANITATION PERMIT Permit No. _ - <br /> F 1� (Complete in Duplicate) Date Issued <br /> - <br /> pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein delscribed. <br /> This application is made in compliance with County Ordinance No. 549. 1 11 <br /> 1 <br /> JOB ADDRESS AND LOCATION ----------� ------•-••---------------------------- -•-I------ <br /> Owner's Name --,- - Phone <br /> Address----------------------------------------•-•----'=--------•--------------- -..-----------------•-----------------------------------..__. --------------------•--------•-- II •----- <br /> i <br /> Contractor's Name ` - ------- -----• -------------------•------------------------------------------------ Phone--------------------- •---------- <br /> ( Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> ( --- �Number of living L�Lits: -------- Number- of bedi•ooms�__-_.--..Number,of baths . �Lot.s <br /> size�____-� � �.� <br /> -� <br /> z Water Supply: Public system Community system ❑ Private El Depth to Water Table __--_-_- ft. <br /> Character of soil to a depfh of 3 feet: S Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobai�Ha�rdpan ❑ <br /> Previous Application Made Yes No ❑ New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i I <br /> S is CT Distance from nearest well--______ _ `- :-_'is`tance from*f"oundation--------------------Material------------------- ___.._.______ --------------- <br /> i <br /> ` iNo. of compartments_________ _------------Size-----------------------''-----Liquid depth_-------------------------Capacity-------i---------------- <br /> Disposal Field: ,Distance from nearest well._ distance from foundation___-_� _. Distance to nearest lot line_L-- <br /> -. U <br /> Number of lines___.___-_-.- _ _ Length of each line______________________________Width of trench...---- -- ri�..____--.._.- � <br /> < y Q.f� <br /> Type of filter materia Depth of filter material ___._______.Total length------------__ --------��............... <br /> -------- ----- <br /> s , <br /> Seepage Pit:# Distance to nearest weEl______________________Distance from foundation------------------ to nearest lot line-11 <br /> ❑ Number of pits. ----°--------------Lining material-----------------------Size: Diameter----------- - -------Depth-----------------I--------------- <br /> Cesspool: <br /> - --- - - -•Cesspool: Distance from nearest well------------------Distance from'foundation--------------------Lining material__________________----_-_-_-_--_-_-- <br /> Sian: Diameter------------------ -------------- ----Depth---------------------------------------- --------Liquid Capacity----- ------------II--------gals. , <br /> Privy: Distance from nearest well _-_--.._-_�_---- --------------_---------------D,istance from nearesr building---------_-__.__----------' ------------- <br /> ❑ Distance to nearest'lot line------- �— ------------ --------------- <br /> - -- ----- <br /> Remodeling and/or rep`airiny (describe)--------- ---------- ------------- ------------•----------------•- - •------ ----------------------------------- <br /> ---------.•----.---1--------------- <br /> -------------------------------------------------------- <br /> ----------------------I-------------- <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, .`n0-rules and regulations of the San oaquin Local Health District. �I <br /> ���------------------------------------- '- Owner and/or ��Ontractor <br /> (Signed} i w ( / <br /> By:------ --•=•--I-- ---------------------- Title i <br /> (Plot plan, showing sizeof lot,11ocaflon of system in relation to wells buildings, etc., can be placed on reverse side). j 11 <br /> FOR DEPARTMENT�USE ONLY ' Ilk <br /> APPLICATION ACCEPTED BY------------- ----------- --------------`------------ ------------------ DATE------G <br /> REVIEWEDBY---------------•--------------------------- 1.--- ----------------- ----------------- -------------------------------• DATE------- ----------- <br /> BUILDING <br /> ---------BUILDING PERMIT ISSUED-------------------- ---------------•---------------------------------•---------------------------- DATE--------------------- <br /> Alterations and/or recommendations:--_--_ ..-. .--..- - ---------- -- ------- -•--------•---`•••- �� <br /> --- ----- <br /> --------`----------------------------------------------------- ------------ -------------------------- <br /> ------------- I <br /> -------------------/"/V-%r7 <br /> --------------------------------- ­---------------------- --------------------------------------------- -------------- <br /> f <br /> r . <br /> AO <br /> FINAL INSPECTION 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 /> l Stockton, California Lodi, California Manteca, California Tracy, Californiel <br /> I; <br /> ES--9-2M l0-52 Revised W-2100 II <br />