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l-UKUI-I-K_L USE: <br /> y <br /> ______________________ _a Q -- APPLICATION FOR SANITATION PERMIT Permit No. . .3- <br /> {Complete in Duplicate} <br /> This Permit Expires 1 Year From Date Issued 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 CATION _ - ?-- - _ 17-- o �- - <br /> -- <br /> Owner's Na a----- ---- ---•---- ----------------------------------- -------------------- --------------- Phone..----------------------------------- <br /> Address 4&-... ----- <br /> / ----------- <br /> Contractor's Name - ------------ "� <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/__- Number of bedrooms _�._ Number of baths /--- Lot size _______- <br /> Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table -9 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam © lay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date----------- ) No ❑ New Construction: Yes ❑ No 24-"FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se is Tank: Distance from nearest well-------------.---Distance from foundation--------------------Materia{------.------------------._._-.-----...._______- <br /> No. of compartments--------------------------Size-----•-------------------------Liquid depth--------------- ----- Capacity---------------------- <br /> ' r (- <br /> Disposal Fi d: Distance from nearest well-Cri)____..__Distance from foundation.-/Q_--.___.__Distance to nearest lot line_��-- w <br /> Number of lines___.___t�___ __ Length of each line____ _`___.j------Width of trench_._�.�_�_---_______________ <br /> Type of filter material-___S� _Q �__Depth of filter material____�l ._..____Total length___________ <br /> ------------y-y---- <br /> Seepage Pit: Distance to nearest well/0-Q-___.____Distance f om foundation--- 4--------.Distance to nearest lot line,5._��'�L.. <br /> Number of pits- _ --------------Lining material _4-/ '.....Size: Diameter.__.3 ..........Depth___aS -----------_---- <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material--------.--------- <br /> _.________.___.___. <br /> ❑ Size: Diameter------- ------------------------------Depth------------------------------ - ------------------Liquid Capacity--------------- gals. <br /> Privy: Distance from nearest well...----------------------------------------------Distance from nearest building-------------------------------------_._ <br /> ❑ Distance to nearest lot line---------------------------- <br /> Remodelingand/or repairing (describe):---------------------- --------------- --------•------------------------------------------------------------------------------------ --------------- <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 la s, and rules a regulations of the San Joaquin Local Health District. <br /> (Signed)------------------------ ------- �[Qwnernd/or Contractor( <br /> ------ <br /> By:-------------------•--•---------- ------ ------ - --------------------------------------------(Title) ------- <br /> ------- <br /> (Plot plan, showing size of lot, ocation of system in anon to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------- --- ---------------------------------------- DATE---f "------�`- --- <br /> REVIEWED BY - --------- -- DATE <br /> ' BUILDING PERMIT ISSUED-------------------------------------------------------------•--------------------------------------- DATE---------------------:. j <br /> Alterations and/or recommendations--- --- -------- - ------------------------------------------------------------------------------------------------------ ------ ------------------------- <br /> •--- ----------------------------­_---------------------=--------------- ------- ------ - ----------------------------------------------- -- ------------ <br /> FINAL INSPECTION S .-f <br /> P - Date-------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CC. <br /> r �� <br />