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FOR OFFICE USE: <br /> ---------- ------------------------------------ C> <br /> APPLICATION FOR SANITATION PERMIT Permit No. 1_7 <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 /> J�0 C AT 10 N <br /> - ------ -------- <br /> JOB ADDRESS AND ---------- .- __K� ---------- ---------------- - ..... <br /> ----------- ------ ---- <br /> Owner's Nam --- ------------•----•-------- ---- -------------------------- --- --- -------------- ------- -------------- Phone--------------- ------------------- <br /> Addres........- ' _72 <br /> �-------------------------------------------------------- <br /> -------------- ------------------------------------------- --- --- --------------------------- <br /> Contractor's Name---------- - ----- -------------------------- --------------- Phone.. <br /> Installation will serve: lResidence Apartment House E] Commercial F <br /> r Trailer Court El Mofel�0 Oth [I <br /> Number of living units:..--/---- Number of bedrooms ---71-Number of baths -------- Lot size ------------I---------- <br /> Water Supply: Publiclsystem E] Community system E] Private � Depth to''Water Table -------- ft. <br /> Character of soil to a'de Adobe depth of 3 feet: ' Sand E] Gravel [] Sandy Loam E] Clay Loam ❑ Clay e E] Hardpan E] <br /> Previous Application Made: (If yes,date-------------- ------) -No E] New Construction: Yes E] No E] FHA/VA: Yes E-1 NOE] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:- <br /> (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) w . <br /> I 1 .1 <br /> Se tic' Tank, Distance from nearest well-----------------Dista ce from foundation--------------I------Material----------------------------------------------- <br /> �A me'nfs-!_.!;L .....-.-Liquid depth.---'- •---'-'•-'--------.Capacity--------- ------------- <br /> �Z r Aj <br /> D;SP056 Field: (lis an ,�fom nearestilwelt-1--l- 10-.......W...Mstance from foundation----1d--_-.----Distance to nearest lot line------�q <br /> I ------------ <br /> Nuinber of lines------------- ._ ____Length of each I line-----y04..............Width of trench-------rX-_ ---------- <br /> Type of filter material- -.,-.---Depth of filter i��afe�,61 ...tS._"____.Tof.aI -length qP ----------------------- <br /> Seepage if: Distance to nearest well----100____----DisfanEe..frorn f undation-----ZO_:---�Disfance to nearest lot line-----------------L�j; <br /> ��__O_____Size: Diameter------ Depth-_-.2-1-------- <br /> E# Number of pits------C,;7---------Lining material___ 01 <br /> Cesspool: Distance from nearest well-----------------Distance frorYi foundation----_------- ......Lining material-_._---___--------------- <br /> 71 Size: Diameter-------'-----------------'-'--- ---------De pt h---------------;--------- -- - ----------.--Li quid Capacify__­.,_P---- ----_..gals../ <br /> Zistance from nearest well___________________________________________------ <br /> Privy- -------------------------- 'T' ;nearesf building-____-_--____--___-_-_________-__...__-... <br /> ❑ (;eDisfance to nearest lot 1ine-------------------------------------------- ---------- -------------------- ------------------------i--------9---------------------- <br /> Remodeling.and/ Frepal6ng (describe):------- <br /> -----------------�----------------------- ------------:r- <br /> --------- <br /> --­-- -----I ------ --- ----- - ----------- -- <br /> - --- <br /> ------------------------------------ ------------------I------------- -----------m------------------------------ - ---- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------7------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance acco ja:nce wiWSan°'Joaquin County <br /> ordinances, State laws; and rules and regulations of the San Joaquin Local Health',Disfric4..__.6 <br /> (Signed)------------------ <br /> -- - - --- - -------- - -------I-----------------�'r--------------------------- ----------------------(3;;iWnd/or Contractor) <br /> —------------------(Title)-------------------- .......... ------- -- - ------- -- - -- <br /> By:--_---_----- -------0--------- ------ -44- -1 4. <br /> i - 1 0 � _'��e4`o 'sidej. <br /> (Plot plan, showing size of lot. location of system in elation to e ui dings, <br /> system placed n reverse <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---/___ - ---------------------------------------------------------- DATE'--- ------------------------------ <br /> REVIEWEDBY----------------------------------- ---------------------- ----- -'------ ----------•-'----------- -------------------------- DATE------------ = -- ----•----------------------------------- <br /> t <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------- ---------------------- DATE----------------------------------------------------------- <br /> A .F <br /> ti ------------- ------------ --------------------------------------------------------------------------------------I- <br /> ---------------------- <br /> Alterations and/or reclornmen a ons:------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- -------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------*----------------------- ------------------- <br /> ------------------------------------------------------------------------------ -------------------------- ---------------------------------- ---------------------------------------------------------------------- <br /> ----- ------------------ -------- ------------ ------------------------------------------ ------------------------------------------------------------- -------------------------------- --------------------------------- <br /> ----F1'NAL7_1WSPECTI0N ------ - -- <br /> SAN J ---------- <br /> OAQUIN.LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelton Ave. 300 West Oak Stree! <br /> 2'4_Sfc.'�,ior.Street 205 West 9+h Street <br /> Stockton,da-dirnia Loci,California Manteca, <br /> ——Tracy,California_ <br /> ES 9 REVISED 0-59 3M 2-'63 r.F-0O3 <br />