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r&k_'6FFICE USE: <br /> - <br /> ----------------------------------------- <br /> ----------------------------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. <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 /> " _011— <br /> JOB ADDRESS A � LOCATION <br /> cQ ,D /Z <br /> ----------------------------------------------- ............... .... ... <br /> Owner's Name.... <br /> i4�- � `��� ` ` ] f Phone..............................�1 <br /> Address-----'.-'/ <br /> (7.4 <br /> ...........11------------------- <br /> .................... .......................................................... <br /> Contractor's Name... 14-- --� `------- ...........-------------------------------I......................... .................. Phone................................... <br /> Installation will serve: Residence k Apartment House E] Commercial E] Trailer Court E] Motel 0 Other E] <br /> Number of living units: ...I---- Number of bedrooms ....i/.. Number of baths __...1. Lot size ..... C C, <br /> Water Supply: Public system [I Community system x Private F] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam [] Clay Adobe 0 Hardpan C] <br /> Previous Application Made: (If yes,date--------- ..........) No� Now Construction: Yes [] No/] FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 'r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> a - I ------M t * I <br /> Sept' Tank: Distance from nearest well-,-MCX! Dist Fe f foundation----I.LL.- ------ <br /> No. of compartments......._., ----------Size 7; ...Liquid c1epth_/,y:..:'7------------ Capacity../_,-Le'__�_.... <br /> Disposal Field: Distance from n7ajest well._/_Q-Z_Z2_Distance from foundat7*0D.... Dist t nearest lot I' <br /> �qtpnce o n in ............... <br /> - ----- ---- <br /> Number of lines.--T-----_------ Length of each line,?_ ... WcTth of trench..-._ <br /> Type of filter material.'- Depth of filter material---- ------------Total length------------ ...... ----*---------- <br /> Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line_-._....-_--_...- <br /> F1 Number of pits----------------------Lining material-----------------------Size: Diameter._.---------.--.-.-.--_Depth__.._......---.._..._............ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-.------------------Lining material------------------------------------ <br /> 0 Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well-._-__-----------------------------------------Distance from nearest bu.ilding-------------------------------------------- <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe):-------•---------------------------- <br /> ------•-------------------•-------•---•---••-----•••••..........--- <br /> clescribe):_---------------------------------...................................................................7------------------------------------------ ------•----- rN <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 laws, and rules-an& I (ions of the San Joaquin Local Health District. <br /> guia ions <br /> 7 <br /> (Signed)------ -------------- ­--- ------ ------- �--------- ------------- --------(Owner and/or Contractor) <br /> By:.................... --------------------------(Title)------------- <br /> -------------------------(rifle)----------------------------------- <br /> --- --------------------------------------------------------------------------------- ------- <br /> (Plot plan, showing siz of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> �n cl g u)a <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------- E <br /> REVIEWED BY--------- ----- <br /> TE_.....; <br /> -----------------------------------*----------------------------------------------------------- - <br /> --_---------------------- <br /> ----- ------ DATE-------------_------------ <br /> BUILDING PERMIT ISSUED <br /> Alterations and/or recommendations:-------------------------- - --------- ------- <br /> .............. --­--------­-----­--------................................................................ <br /> ---------------------------------- -------------------------------------- -------------------_----- ........................................................................................................................ <br /> y , DAT <br /> 2� <br /> :1 <br /> ---------------------I---------------------------------------------------------------I....................................................................................................................................... <br /> -------------------------------------------------- ----------- <br /> ----------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------­ ------------ <br /> ---------------- ---------------------------------------------------- -------- ...... <br /> FINAL INSPECTION BY: ............ --- - <br /> ----------- <br /> Date....... ------------............ <br /> -------------------------- ------ <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 Lodi,California Manteca,California Tracy,California <br /> 9S 9 REVISED 6-59 3?4,,3-'63 F.P.120. <br />