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FOR OFFICE US?: I$ , <br /> ------ 3.130 <br /> :� - Permit No. <br /> C�` .--- <br /> _--" .;.�~-- r `. APPLICATION FOR SANITATION PERMITa- <br /> �� - cc <br /> (Complete in Duplicate) I <br /> -----------A <br /> ---.-..----- <br /> �M'. 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 descrbed. <br /> This application is made in compliance with County Ordinance No. 549. Y/n) OF( r ©r `t. r <br /> JOB ADDRESS AND LOCATION____ Wo ---1 ' - ----�' F `' � i <br /> Owner's Name.__Ft_ �._ --------------------------------- - - ---------------------------------------------- Phone. <br /> Address---- .. ....-•-----•------------------------------------------------------- -------------------------------------------...--•------..--.-.-------------------- <br /> Contractor's Name .� ---...-----4...�- """' �- Phone <br /> Installation will serve: ResideMnceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> 1M' <br /> Number of bedrooms .-_, Number of baths __/_____ Lot size ----------------------------------- ------ ' <br /> Number of living units .__#_ <br /> Water Supply: Public system ❑ Community <br /> system hate Depth TO Water Tabler& ft. <br /> PP Y• Y Y Y ❑ P <br /> Character of soil to a depth E f 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> I Previous Application Made: '(If yes,date....................) No g?-' New Construction: Yes [OONo ❑ 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 /> II <br /> Sept; an � Distancelfrom nearest well-----------------Distance from foundation----------------..-Material------------------------------------------------- <br /> No. of compartments--------------------------Size-----------------------•------•-Liquid depth----------------- --------Capacity--------------�------- -C <br /> Disp Distance Lrn nearest well-2s`'�°'`--/..-Distance from foundation..., ___.....__.Distance to nearest lot line. ..._-..- <br /> Number ;bf lines--------- Length of each line.-_.j_'_________.-----.Width of trench--* _9___________._......- � <br /> Type of filter material__._ -------Depth of filter material: 9'_-*'____-_.____Total length__: "____________________________ <br /> Seepage Pit: Distance '.�to nearest well ,06...........Distance from foundation_A_f__.........Distance to nearest lot line. . <br /> ❑/ Number 'af pits________'------------Lining material._"_R_Q(._4----Size- Diameter----33"..__.....Depth---Z ------------------- <br /> Cesspool: Distanc4ifrom nearest well---------------- from foundation--------------------Lining material------------------------....... <br /> .____. <br /> ❑ Size: Diame+er- -- --------------------------------Depth------- Liquid Capacity" .....gal . <br /> Privy: Distance]from nearest well------------------------------------------------- from nearest building----------------------------.-------"----- <br /> ❑ Distance to nearest lot line---------- -------------------------=-------------•-•---------------------------------.----------------------------------------------------- <br /> Remodeling and/or repairing (describe)--------------- �� ' --------- ----- V ..----------------- <br /> ----------------------- <br /> -•------------------- '�� <br /> ej� <br /> 4. ,-..... ._.,� •>< _ ---------------•-----------------• -------------------------- -------•--....------------ ----- _ <br /> ....................... _. -- ----. --- <br /> -------------------"-"--------------------------•-----------•------.-.-----------------------------•---------------------.-------•-•--------------•"------------•----•----------------------.---------------------------- <br /> hereby certify that I Piave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regu tions f the n Joaquin Local Health District. <br /> ` -------------------------------------------------- •-----•----------- Owner and/or Contractor <br /> (Signed)-"--------------------------------il { / ) <br /> By:-----------------------••----Il-------------------------.------- -----------------------------------------------------------------(Title)-------------------------------------------------- <br /> ...------------------------------------------ - -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> .ill <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED!BY-.- ._ <br /> - Com---- ----------------------------- ---------- DATE--- 1.' 4....----------- <br /> REVIEWED BY......... -I ------- DATE <br /> - - <br /> ' BUILDING PERMIT ISSUED : --- ----------------r-------- ---------------------- .._. DATE-----.-,- <br /> - ,^ <br /> Alterations and/or recomm4 is atipns: ........./�'r-t- °may`--- = <br /> ------------------------ <br /> ',w� <br /> -a` �w� _ C � '- ---- � - ...................................... <br /> p �' <br /> �` z` � '� '-` � "---------` -------------------------•-----------•--"--------------•-- <br /> :I� ---------------------------------- --------•----------------------------- <br /> ------------------------------------ -- --- --�M ----------------"------- --•----- ---•---------•---------- ------•-----------•--------------­------------------------------------------------ -------------------------- <br /> FINAL INSPECTION By-. 44PI � =/ - - Date. --�j "' <br /> - <br /> I SAN JOAQUIN LOCAL-4ALTH DISTRICT <br /> 130 South American Street 300 West Oak Street ; 12.4 Sycamore Street 205 West 91h Street <br /> F Stockton,California Lodi,California ` Manteca,California Tracy,California <br /> ' ES 9 REVISED 9-59 21A 5-62 ATLAS <br />