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FOR OFFICE USE: <br /> ---- ----------------------------- <br /> APPLICATION FOR -SANITATION PERMIT, Permit No. <br /> - ----------------------- <br /> ---------------- ---------------------------------------- (Complete in Duplicate) /6A <br /> ----------------------------------- -- ------------------ This Permit Expires I Year From Date Issued Date Issued _1�­Y/�_� <br /> tl,pplicafion 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 /> JOB ADDRESS AND LOC jATION_d�3.z_,3---- ---------W------------------------------------------------------------------------------------------- <br /> Owner's Name-- -`----- - ------------------------------------------------------------------------------------------------------- Phone_---------------------:------------ <br /> Address...... <br /> -- ---------------------- ------- <br /> ------------------------------- - - - - <br /> ------------------------------------------------------------------------------------ <br /> Contractor's Name� - ._'_ ------------- - ---------------- --- ----------------- Phone----------------------------------- <br /> Installation will serve: Residence UT--Apartment House E] Commercial L] Trailer Cou.r't [:1 Motel [:1 Other ❑ <br /> Number of living units: -1---- Number of bedrooms j---- Number of baths Lot size ------- ——---------------------- <br /> Wafer Supply: Public:system El Community system F] Private De pth to Water Table 4�ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] San Loam [-] Clay Loam [] Clay ❑ dobe Rl"Hardpan El <br /> Previous Application Made: (If yes,date_.-________;__--..-_) No [J��*M., Construction: Y s , P_? <br /> Newe E] No-M' FHA/VA. Yes F1 No e__1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi T k-� Distance from nearest well-----------------Disfa'6ce from foundation--------------------MateriaL---------------------------------- ------------- <br /> No. of compartments------ ------------------Size------_----------------- uid cleohl-------- --------------�Capacity----------------------- <br /> "'T <br /> ► <br /> D;sposal_Fieicl: Distance from nearest well.4-�------1.-.Distance from fou a ._J ADistance to nearest lot line___________ <br /> Number of lines-- . ..... ........... <br /> ----------------Length of each Ili ---- -------- ---------------!Width of frencbppl.-A----- <br /> Type of filter mafe_r1aI`_11_&_C__,f.........Depth.of filter m6ferialll--------------Total length <br /> —---------------------- <br /> Seepagg P-it: Distance to nearest well__10.............Distante from founclation-JA------1------Distance to nearest lot line-----PC- bi <br /> Number of pifs-------f-------------Lining material_ J706-It----Size: Diamefer'3-3...............Depth-------RIC—---- -- ---- <br /> Cesspool: Distance from nearest well_______________:Distance from fou'ndation- - ----------------Lining material-.----------------------------------- <br /> ElSize. Diameter--------------------------------------Depth--------------------------=-----------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest ----. - ---------- Disfance,frorn nearest building—-------------------------------------- <br /> Distancetonearest lot line----------------------------------------------•--------=---------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing;(describd):--------- ----------------------- ------- -------------- ---------------------------------Y-7—------------------------------------------------------- <br /> ------------------------------------------ ----------------------------------------------------------------------:--------------------------------------------------------------------------------- <br /> -------------------------------------------------t,------------------------------------------------------------------------------------------------ ----------------------------------------------------------- ........ <br /> --------------- --- —--------------------*'*------ <br /> n� �'a <br /> on <br /> Ae Joa <br /> a S <br /> pre P r P <br /> es and reguaf' s -of an <br /> ..................--------- ----------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- <br /> epare this plli�aq6n­�ind that the work will be done in accordance with San Joaquin County <br /> I hereby certify fhati have pr' <br /> ordinances, State laws, and rules and regula.fi sof " -San Joa uin Local Health District. <br /> (Signed)------------------- <br /> -------- ------------------- ----------- ----------------------------------------------------------------------(Owner and/or Contractor) <br /> By:--------------------- . ...... ....... --- -- --------- ---------------------•-----------------------(Title)------------------- ------- - -------------- ------------------- <br /> f <br /> 71 of <br /> 5 0 w <br /> (Plot plan, showing size�o of n of sfemW in relati n fc;wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------1 CC- <br /> ................................... ---------------------------- DATE----` ''`� f - ^ <br /> I REVIEWED <br /> ATE------ <br /> REVIEWEDBY--------------------------- ------ ---------------------------------------------- ------------------- ------------- DATE-------------------- <br /> BUILDING PERMIT ISSUED----------- ___:----------------------------------- ----------- <br /> ------------------------------ ------------------ DATE------------------------------------- <br /> Alterations and/or recommendaflons--------------- -- - ----­---------------- --------------------------------------------------------------------------------- <br /> - <br /> ----------- <br /> ---------------- ...... /�-----------------------------------:------------------------------------ <br /> ------------------------------- I------------------ --------------------------------------- --- ------- -- ------------------------------------------- ---------- ---------------- --------- <br /> -------------- <br /> -------------- .1 <br /> - & '6,3----------- <br /> —`�;;� ----- - ---------------- <br /> I <br /> ------ ------------_---------------- - ------------------------------------------------I-------------------------------------------------------------------------------- ------------ ------------------------------------- <br /> • <br /> FINAL INSPECTION BY:---------4--------------—--------I--------------------------- Date------ ......---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Noxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.F.CEI. <br />