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FOR OFFICE USE: <br /> -----------------------------------_ <br /> ------------------ ---------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. __-- '_ <br /> ----------------- ------------------------------------- <br /> - ------------•-------------- ------------------ -------- (Complete in Duplicate) 6 <br /> Date Issued -.-•--------- -------- <br /> ---------------------------- ------------------------------ This Permit Expires 1 Year From Date Issued _ Q_scn ed. <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to constru�nd install the orere <br /> This application is made in�complaance v t County Ordinance No. 549. <br /> JOS ADDRESS AND LO ATION__ _-•-•- O-• - � r <br /> Owners Name _ <br /> 1ttv <br /> 'vYU:- Phone': <br /> Address-------•------- / ----- ------ --•--------------- _= •----------------•-------------------------------- ------ <br /> Contractor's Name--- --•-------- Phone ._... <br /> •---- - <br /> Installation will serve: ResidenceApartment House ❑ . Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __t-. Number of bedrooms I__ Number of baths /---- Lot size ".- ------------------------------- <br /> Q€t. <br /> Water Supply: Public system ElCommuriity system El Private Depth to Water Table __ <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--- ----------------1 No ®°"^ New Construction: Yes [L'lo ❑ FHA/VA: Yes [�jl No ❑ +� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1n <br /> _ .=.(No septic..tank.or.cesspool.-permitted if.public se'wer.is available within 200 feet.) <br /> 04 <br /> Septic Tank:. Distance from nearest well_-�a_____Distance from foundation_40-----------Material---C__C___�� -- G__�____-.---_ <br /> No. of compartments-----Z----------------Size A__3(49Liquid depth-------Z--------------Capacity <br /> __ <br /> Disposal Field: Distance from nearest well-4-40_----.. Distance from foundation___ t ____......Distance to nearest lot line.- .___.____ r <br /> dr 0 <br /> [� Number of lines------/-•-----------------------Length of each line----- -------------------Width of trench. <br /> j_/ --,------•----------..._ <br /> Type of filter material� _ 9_ACXDepth of filter material____.f.?_��-___.Total length_.__ a -*------------••--------- <br /> Seepage Pit: Distance to nearest well ._1.0A_ ----Distance from foundation__-- Distance to nearest lot line___ ____________ <br /> Number of pits----/---------------Lining material---_O .,.Size: D•iameter____ .--------.Depth__.�. _�.-----•---•-•--- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation..------------------Lining material_---_-__-.__._.-___.__...._________-. <br /> ❑ Size: Diameter-------------------------------- ----Depth-----------------------------------------------------Liquid Capacity--------------------------gals. <br /> Privy: ------------------_Distance from nearest building____--___________---__________.-.-----_-. <br /> Priv Distance from nearest well -------------- --- - ----------•---------------------•--------------------- <br /> -------------------------- <br /> Remodeling <br /> -�----------------- <br /> Distance to nearest lot line--------------'- ------------------------- ----••---- - ------- - <br /> Remodeling and/or repairing (describe):________-'--------------- ____ - ---- --_----- <br /> ----------------------------------------------- <br /> -------------------•-------•-•-•----------•---------------•---•--------- <br /> ------------------•--•-------------------------------------------------------- <br /> i � 1 <br /> ------------------------------ ------------------------------- <br /> ----------------------------------- -----•---------------------------------•- -------------------------------------------••------ <br /> ---------- L-'---------•---------- -----•------------------------------------•----------------------------------------- <br /> -------------------- <br /> I hereby certify that I have prepared this'applicafion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. <br /> - _ r Contractor) <br /> {Signed)--------•---`�--Tw'� ---------------------- ------------------ ------------------ - <br /> ---------- <br /> ,.._� <br /> (Plot plan, showing size of lot, I ion of system in relation to wells, build Ings, etc., can be placed on reverse side).- <br /> FOR DEPARTMENT.USE ONLY, <br /> ACCEPTED BY------ T; Q ' ------------------ DATE-----------�_'_ ------------------------------------ <br /> APPLICATION 0 <br /> + --------- --REVIEWED BY----------------------------------------- --• -------------------------------------------------------- �t----------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------•--------------------------------------- DATE---------------------•-------------------------------------- <br /> Alterations and/or recommendations------------------- ----------------------------------------------------------------------------------------------------------•-- <br /> ' ----------------------------------- ---------•-------------------- ----------------------------------------------------------- ----•----------------- <br /> -----------------•--•---------------•--------------------------•- -------------------•-------------------- <br /> �A_ <br /> FINAL INSPECTION BY----------------------•---- f = Date-------------- -- -----------------_--------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1130 South American Street 300 West Oak St►eet' : 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Locil,California Manteca,California Tracy,California <br /> EB•9 REV�SEC e-99 F.P.0 P•SM 6 6P <br />