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FOR OFFICE USE: <br /> ---------------------------------- ---------- <br /> ------------------ ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .......... <br /> ----------- ------- ------------------------ (Complete in Duplicate) - Date Issued <br /> -- -- ------------------ ---------------------- This Permit Expires I Year From Date Issued <br /> Application 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 CATION_..._.__h - --- ----- ---f----------------------------------- .................................................................... <br /> Owner's Name-------- -4.,Ae,---- ---- <br /> ---------- Phone------------------------------------ <br /> Address----------- I......... <br /> -- - --------- ---- --- ------------------------------------- ------------------------------------------------------ <br /> Contractor's Name-____-- <br /> ----- ---- -- <br /> ---- --------- -- -- - -------- --------------------------------------------- Phone----------------------------------- <br /> Installation will-serve: Residence E], Apartment House E] Comm'ercial [K-"Trailer Court El Motel 0 Other ❑ <br /> Number of living units:*-____ Number of bedrooms Number of baths Lot size _jO7- -f'•._. ..�.�:------------------------------- <br /> Water Supply: Public system El Community system F] Private 2!(eDepfh to-Water Table -------- ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy,Loam Clay Loam 0 Clay [] Adobe 0. -Hardpan <br /> Previous Application Made: (If yes,date---------------- No-E] New Constru!c'fion: Yes E] No E] FHA/VA: Yes I-] No El <br /> K) <br /> TYPE OF INSTALLATION AND SPECIFICATIONS.- <br /> (No septic.fank or cesspool--permitted if public sewer is available within 200 feet.) <br /> Septic-Tank: Distance from nearest well-___-_._..___.__Distance from foundation--------------------Material------------------------------------------------- <br /> ❑ No. c;f'corr'partments------------ -------------Size----,-,C-1---------------2--------Liquid depth----------------i---------Capacity-------------- -------- <br /> Disposal Field: Distance' from nearest we1.---------------Distance from foundafi(7n---I ----------Distance" to nearest lot line"_--"_----_--._"- 11; <br /> - I <br /> F9 Number of lines--------------------------- ---=Length of each-line----------------------s----:Width- of french------------------------------------ <br /> Type of filter material--------------------- ---Depth of filter material--------------------.--Total length_____.-_"_-_____"_---_-_._---------------- <br /> Seepage Pit: Distance to nearest well_.--- �-------Distance <br /> from foundation____ _..___.Distance to nearest lot line__.__ -�_____._ <br /> Number <br /> ine------- ----- <br /> Number of pits..-____1-------------Uning-m9te ria I Size: Diameter-----V.� --------Depth___ ---_-._-_"-______._ <br /> Cesspool: Distance from nearest well--------------.--Distance from foundation....................Lining material-------------------------------------- <br /> 0 Size: Diameter----------- <br /> ----- -------------------Depth----------------------------------------------------Liquid Capacity- ..------------------------gam <br /> Privy: 1' Distance from nearest well--------------------------------------------------Distance from nearest building.-_._...__"___-______-_____.__.___.__. <br /> ❑ f Distance <br /> uilding.----------------------------------------- <br /> Distance to nearest lot line---------------- --------------- -------------------- <br /> Remodeling and/or repairing (describe):__._-" ------ ---------------------- -------A-V-,Z- -------------------------------------------------------------- <br /> -----------------%_---------------------------------------------------------------------------------------------------------I----------------------------------------------------------------- <br /> --- ------------------- ----------- <br /> -------------------=------------------------------------------------------------ <br /> --6----------------- ---------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- <br /> -- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> certify fha+ I have prepared This application and that the work will be done in accordance with San Joaquin County <br /> I hereby <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed}--- - -- -----------------------.----=-------------------------------- --- --- ------------- ------------------------(0vrrre45 and/or Contractor) <br /> - --- ------------ -- ------ <br /> By:___ - . __ —=%_____ - � -— - - ---------------------------- <br /> ---- ------------------------------------- ..... (Title)� <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 ------------------ ----------------=----------------------- DATE---'V--- 7 <br /> REVIEWEDBY-------------------------------------------------- ------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------- --------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:----- - ------ - - -------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------­­­---------------------------------------------------------------------------------------------------------- ........ ------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ...... ------------------------- <br /> ------------ --------------------- ----------------------------------- ----------------------------------------------- ---------------------------------------------- -------•------------------------------ -------- <br /> SPECTION ------------------- Date-- ------ -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Loch,California Manteca, California Tracy,California <br /> F.R 013, <br />