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- � 5 <br /> /r D APPLICATION FOR SANITATION PERMIT Permit No. �Q..f <br /> 4yf�� (Complete in Duplicate) Date Issued ____/��,z/ d ' <br /> E This Permit Expires 1 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 LWOC ------ _ '° ---- ----� -------------- <br /> Name-------------- __ __ /� <br /> 1,1 - - -- - -- --- ------ ------------------ Phone <br /> ------------ <br /> t <br /> Address--------- --------- --•-- ... <br /> ---------- <br /> Contractor's Name f• ----. Phon <br /> InstaaN <br /> ion will serve: iResidence Apartment House Commercial Trailer Court Motel ❑ Other F1umber of living units: JE] E] E]umber of bedrooms .Number of baths ___1_ Lot size __--__.,; .�r __�e �___--__________________ <br /> Water Supply: Public systemCommunity system F­1Private E] Depth to Water Table ------ ft. <br /> Character of soil to a depth oK3feet:ISand ❑ Gravel ❑ Sandy Loam ❑ CClllaay Loam E] Clay E] Adobe Hardpan ❑ <br /> Previous Application Made: Yes p Nol New Construction: Yes ❑ NIX <br /> o pd 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 /> ept� Distance from nearest well_________________Distance from <br /> foundation-----------___.___.Material__:__-.______..________________-__._.____.___. <br /> No. of compartments------------------------sSize-�-----------=-------------r Liuid depth-------- ----- CapacitY-•--- <br /> - - -- ---- <br /> ' iyias FreId: Distance from nearest well__�. Distance-from foundatio= '.Distance to nearest lot line____ -�� <br /> .Number of lines_,---st-------------------- --Length of each line-----------------------------.Width <br /> of trench.---------------------------------- <br /> AType of filter material___-__________.___ __Depth of filter mat erial______________________Total length_____-__-___________._--__________-_______ <br /> Seepa Pit: Distance to nearest well__1 __Distance from foundation__,e"O---__-:-:.Distance to nearest lot line_____.___-_. <br /> Number of pits._____'I------------Lining material ______�4f Size: Depth_-_-�U ----------- <br /> esspool: Distance from nearest well-----------------Distance from foundationa._.__.<_.______ Lining-material ____.______..________._____-___-_. <br /> ❑ Size: Diameter_------------------------------------Depth-----------------------------i s-.------ r-Liquid$Capacity- - ----------------- -----gals. <br /> Priv Distance from nearest well---------------- -- .________._.-Distance from nearest buildin <br /> ❑ Distance,to nearest lot line------------------------- --- --------------- - ------------------------------- ------- -------------------------------------- <br /> s, <br /> / h�f <br /> Remodeling and/or repairing (describe):__. _ __ ________!____=_____ <br /> y --------------------- <br /> ----------„ - --------- <br /> - - - <br /> ------ ------- --- - ----- ---- <br /> 73----- ' <br /> - 1 ------- <br /> --------------------------------------------------I----------------:---- <br /> ----------------------------------------------------------------------------- -----------------•------------------------------------------------------------------------------------------------------------- <br /> I hereby car{ify {ha{ I ha'�yA prepared this 9�pp4e.Ation and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, an a 4annegula ' ns of a San Joaquin Local Health District. <br /> - Owner and/or Contractor <br /> (Signed) �� - ( I <br /> By:------------------------------------ -----•---; (Title)-- m ------------ <br /> (Plot plan, showing size of lot, location of. y in re ation to wells, buil in tc., can be placed on reverse side). <br /> F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- --. --- - --- - -------------------------------------------------- DATE-,,,,�----=or ----------------- <br /> REVIEWEDBY DATE ---------------------------------------------- <br /> BUILDINGPERMIT ISSUED------- ---- ---------------------------------------------------------------------------------------. DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:----------------------------------------------------------------------------------•----------•---------------------------•--•---•--------------------------- <br /> ------ ----- ---------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------- ----------- <br /> ------ ------ <br /> --------- -------- ----------- -------------- -- <br /> ------------- ------------------------------:•--------------- ------ - -- - -- ------------ ------- --- •-----•---------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY-- - -- ---------- - --- - --- --------- -------------- Date.--- _`�1 ------------------------------------ <br /> 5AN J AQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C” Street <br /> Stockton, California Lodi, California Manteca, California Tracy, Calif' <br /> ES-9-2M Revised 8-'S9 F.P.Co. �7 <br />