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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> ------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------------------------- <br /> . .... ,o .. <br /> ------- ---------------_ ----- -------------- ------ (Complete-in Duplicate) Date Issued <br /> ,� <br /> __..................... ...._...-_________________. This Permit Expires 1 Year From Date Issued <br /> G..______._ . <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. y� � <br /> JOB ADDRES LOCATION. Q. _. _ .a ----------------------------------------=---------------------------------- <br /> Owner's Name��.e W_Z.-----4Z-.---..---- - -- ------ Phone <br /> Address__ - 0 Q z9t1 ��t+ '_ <br /> -&_j���11 ----------------------------------------. .--------•-------------------------------.. <br /> Contractor's Name , � ----------------- •------- ----------------------------------------------- Phone----------•-----•----.........---- <br /> Installation will serve: Residence 14 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ <br /> Number of living units: --- Number of bedrooms Number of baths J----._ Lot size -__-,� <br /> -ate. ____T___._% .. <br /> ---------------- ---- <br /> Water Supply: Public system ❑ Community system W Private ❑ Depth to ater Table _�__ _ ft <br /> Character of soil to a depth of 3 feet- Sand JE Gravel E], Sandy Loam Clay Loam ❑ Clay ❑ Adobe 0 Hardpan IM <br /> Previous Application Made: (If yes,date---------------.--- ) No ❑ New Construction: Yes ❑ No ❑ 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 /> Septic Tank: Distance from nearest well-----------------Distance from foundation__.-.---__--_--_..Material ---------------------.------------------........ <br /> No. of compartments_-----------------------Size-------------------- -----•--•-Liquid depth--------- -- _ ------ Capacity....................... <br /> D sal Field: Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line----------------- <br /> 0 Number of lines---------------._.---------------Length of each line__---------._-------........Width of trench-----_--_---__-__--__.-.-.--__---._ <br /> Type of filter material--------------------_----Depth of filter material.......----------------Total length------------------------------------------ <br /> � <br /> Seepage Pit: Distance to nearest well__2�2� ___Distance f foundation___ p_0........DisAO ance to nearest lot line.... ......... <br /> S-"_1 Number of pits._.__.f_.__..-_.__Lining material -_ Size: Diameter-04/096 Depth---.-""-'�-------------- <br /> '' <br /> Cesspool: Distance from nearest well _______________Distance from oundation_ -------------. ..Lining material___..____.__..__________________. <br /> ❑ Size: Diameter- -- --------- ----- ----------------Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----------------------------------- -------------Distance from nearest building------ _._.----------._------------._.--_--. <br /> ❑ Distance to nearest lot line----------------- f ---- ----------------------------•------------------------------------- �-------- - <br /> Remodeling and/or repairing (describe):- ------------L ---------- '.--- - -- -----• [ „ <br /> -----------------•-----•-•--------------------------------------------- ----- •-------- ------ "P <br /> ----------•----•-••----------------------••-----------•--••-------•--•----------•-------------• -•----. ---•-------- ---•------------------•----------•---------------------------------------------------------------­---- <br /> ------•---------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--- ----- ---- - -- -- -- ------"------------- - ------- -----------------------------(Owner and/or Contractor) <br /> ' _-_Title <br /> B <br /> (Plot plan, showing size 0f lot, Iota n of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY VJ <br /> APPLICATION ACCEPTED f -------------------------- -- ------------------------- -------------- DATE------! _iff <br /> REVIEWEDBY----------------- ------- ------------- _- --------------------- ---------------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSt2 --------------------------------------------- -------------------- DATE------------------------------ 1 <br /> Alterations and/or recommendations:---------------- ------- -- --------------------- --------- ----------------------------------------------------------------------------------------------se, <br /> --------------- -------------------- ---------------------------------------- -------------------------- ------------------------------ ----------------------------- <br /> -------_-------------------------------------------------------------------------------- ------------------------_--------------------------------------------------------­­---------------------------------� <br /> ------------ ----------------------- _----- <br /> FINAL INSPECTI BY:�, V?i;,1._. Date--- _' - _ <br /> --- ------------------------------------------ <br /> SA AQUIN 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 /> E.H.9 2M 1.67 Vanguard Press <br /> 9�g <br />