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rUK UI-r1C.L USE: <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 />Thisa plication,fs . ade,in,compliance with County Ordinance No. S49: 017– (x90...5( <br />JOB ADDRESS AND OCAITONq/e.7!tt%.1st. �.r °1 <br />....................I_............................................................ <br />Owner's Na I <br />,//��' ...... ..................................... Ph <br />Address.._..... A.t%s._b+ . ... ..._..€ `7l.�... .......:.. Phone .................................... <br />k....�P- s�-+i� <br />r ... ................................-.............. <br />Contractor's Name.......... � . �..............'.._................__..... <br />.....-•✓• ........ Phone...... ..... ; . <br />❑ ❑ <br />Installation will serve: Residence El Apartment House ❑ Commercial ["�Traiier. Court Motel Other <br />I Number of living units-. ....�. Number of bedrooms .^-:--. Number of baths y ".. Lot size <br />Water Supply: Public system _..................... <br />L <br />❑ Community system ❑ Private �epth to Water Table ........ ft. <br />Character of soil fo a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Cr�Clay Loam E] Clay [] Adobe ❑ Hardpan <br />Previous Application Made: Ill yes,Idate..... ......1 No ❑ New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ No ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: t <br />(No I. <br />-tank or cesspool permitted if public sewer is available within 200 feet,) <br />Septic Tank: . Distance from nearesf well. ............. <br />... Distance from foundation .................. Material.. ......__..... , <br />El No. of compartmenls....... ................. <br />.Size ................ Liquid depth............. Ca...aci.` <br />D sposa Field: Distance from nearest well--�!?:�-.Distance.frorn foundation......�.o..�... Distance to nearest lot fine.... s..� <br />I Number of lines............. <br />t Len th of each line..(A...'..... ..._... Width of french......Z. <br />I Type of fiiter material....... 's�? �Depih bf filter material.. l.f........... Total length. ....... f 0•! <br />Seepage rf: Distance to nearest well. .�°a.�..?�' Distance from foundation..' .1.P.!::.......bistence io nearest lot fine.... s.�..... <br />Number of pits_ .._ -.... ... Lining material... AA._! .... ...Size: Diamefer ,2.;,..ys,.__, pepth......? t............ <br />Cesspool: Distance from nearest wall..........':: Ditty cc from foun�ion ......~....... � xx <br />A. ..Lining material.. ..................... <br />/ <br />Privy: <br />Size: Diameter .... <br />........ �..... Depth............ ....' .... ............... ......Liquid Capacity.......... ..._...........gals, <br />-_ <br />Y Disfarce from nearest wall �..Uistance from nearest bui'ding. ............. <br />. ,11.,. - <br />................... <br />El <br />Distance to nearest fol line... .......... ' ,:,-• . ' •' "-'•.---•.•• •• <br />.... .......... <br />Remodeling and/or repairing (describe):.. <br />........................................ <br />.................... <br />..................... <br />.----•....................................---...........---...........------..._.........__ ..... _.... . <br />I hereby certify that I have prepared this application and that fhe work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules and. regulations of the San Joaquin Local Health Dis+ricf. <br />(Signed).. <br />. ............ <br />................................................................. . <br />By: ............R-_.... .... .... . (Title) an r Contractor) <br />or) <br />............................. . <br />(Plot plan, showing size of lot, location of cyst m in re! fiion to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />—__— <br />APPLICATION AC;C:EPTFD BY../ _ <br />..... .................... DATE......................... . <br />BUILDING PERMIT ISSUED .............. <br />Alterations. and/or recommendations: ........................ •'"••-" ' <br />' ....:........... `:............ ............................ <br />........................................ <br />........... ...... <br />.. ................... .......... <br />.. <br />1 :...ti .................. <br />... ................I.............. .................... ..... ............. .. <br />............ <br />i <br />� <br />FINAL INSPECTION–BY:-111v <br />��, ..!–�wzi_ �`.......... . Date.. ...... <br />–G/7 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Ha:ellon Avo. t 300 Woo Oak Strom <br />Stockton, California Lodi, Californla <br />F.P.cc). <br />124 Sycamore Street 205 Wost 9th Street <br />Monloco, California Tracy, California <br />