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t-UK UrNCE-USE: <br /> -------------- --------------------------- <br /> ---------- --------------- -------- -------------- APPLICATION FOR' SANITATION PERMIT Permit No. <br /> --------- <br /> ------------------------------------ ----------- __/.._.__ <br /> --- ---- <br /> -----------I--- -------- ------- ---------- (Complete in Duplicate) <br /> X1 Date Issued <br /> ApplicationThil',Permit E fres 1 Year From Date Issued <br /> 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 /> JOB ADDRESS AND LOCATION-.___-_ 7 <br /> I.9" <br /> Owner's Name-------- - -------r-------------------------- ------------------------------------------------- <br /> - <br /> < ----------- ---------------------------------------- Phone <br /> Address--------- 1 f R-A't_L ( _ <br /> Contractor's <br /> ddress-­------ <br /> Contractor's Name--- <br /> ---------I-------------------------------------- ------------------------------------------ ------------ Phone----------- <br /> Installation will serve: Residence Er--Aparfrnenf House E] Commercial E] Trailer Court Ej Motel El Other_E]----_---------- <br /> 1_ Number of baths /---- 'Lot size ----AM � <br /> Number of living'g units. - Number of bedrooms �2 -C ❑ <br /> /5-0 <br /> Wafer Supply: Public system E] Community system F --------- -- --------------------------------------- <br /> I Private Depth to Wafer Table & ft. <br /> Character of soil to a depth of 3 feet: Sand"Gravel L] Sandy Loam Ej Clay Loam E] Clay,E] Adobe El Hardpan E] <br /> Previous Application Made: (if yes,date_______________.__.) NodGa`�New Construction: Yes FHA/VA. Yes [-I No <br /> --TYPE-OF-INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---5 -----Dis#anc from foundation__.__A9--- Mat e lal------ <br /> No. of compartments_..._..._ <br /> ?=---------.Size--- depth_.! '.21 -------Capacity--./ 0-Z) <br /> Disposal Field: Distance from nearest well-570foundation_____ - �_ ;— - r-------------- <br /> - ------Distance from - ------Distance to nearest lot line_______5- <br /> ET--, Number of -3 <br /> _/-----------------------Length of each line-----&-'47)----'t""--.Width of french-- <br /> Type of filter maferja�---RV!�,��---Depth of filter material____/_9P -6-------- ----------- <br /> Seepage Pit: Distance to nearest well ----Total length--------- C7-------------------- <br /> ------Distance from foundation--------------------Distance to nearest lot line <br /> El Number Of pits----------------------Uriirig material---------------------..Size: Diameter--------------- <br /> Cesspool: -- -----Depth----- ----------------------- <br /> Distance from nearest well_-___-___._--___------Distance from foundation------- ---------- Lining material_____________--_-" 9 <br /> Size: Diameter------ ------------------ ------------Depth----- -------- --------------- ----------- <br /> - --------Liquid Capacity- -------------------------gals. <br /> Privy; Distance from nearest well________________________________-_.---------.-Distance from nearest building------------------------------------ <br /> f❑ Distance to nearest lot line____________________----- <br /> .-Owl <br /> Remodeling and/or repairing (describe):--------------------------------- - --------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- ------------------------------ -------------- --------------------------------4------------------------ ------------------------ --------------------- <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. S laws,,and rules and regu tions of the San Joaquin Local Health District. <br /> (Signed)_ <br /> ---------------------------- ------------- --------------- --------(Owner and/or Contractor) <br /> ...... -------------- <br /> By:------------------------------ - - ­_ —_ ' r <br /> -----------------------------------------------------------(ritle)------- -------------------------------- -------- - ---------- -- <br /> (Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___'7_�_j.?. <br /> -.0n-------- - ------------------ -------------------------------- DATE------- --- <br /> REVIEWED BY ------ - ----------------- ---------------- <br /> BUILDING PERMIT ISSUED -------------------- DATE---------- - ------------------------------------------ <br /> Alterations and/or recommendations:------ -----------------------------------------------:1- -------- DATE---------------------------------------------- -------------- <br /> ----------------------------- ------------------------------------------I------------------------------------------------------------------------------ <br /> .......... ---------------------------- ---------------------- ------ ------------------------- ----------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------- ----------------------------------------- ----------- ----------------------------------- --------------------------------------------------------- -------- ---------------------------- <br /> ----­-------------------------------------- ------------­ -1------------------ -------- ---------------------------------- --------------------------------------------------- ------------------ <br /> ..........­­-------- ----- ­-------I---- ----- --------- ----------- ---------- -------- ------------------- ------- -------------------- <br /> IINAL IN111CTIO11- 77 <br /> Date-------------- / <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.00. <br />