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APPLICATION FOR SANITATION PERMIT i <br /> peri+ <br /> (Complete in Duplicate) <br /> Date Issued ___ - - <br /> This Permit Expires 1 Year From 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 /> JOB ADDRESS AND L-OCATION b! a /-- --- <br /> -"`-�--��--°-------- <br /> Owner's Name-------------- fh^£..........ka- o------..-..-•----------------------------------- ------------ .--_ :-.------ ------ Phone------------------------------------ <br /> Address---------------- ��1- r_.011-----. = y �' --------------------------------------------------------------------------------------------- <br /> Contractor's Name---------- �_ ---- ,---- --- - - - - --- - - ----- ---------------------------- Phone---•--------•--------••-------- -- <br /> Installation will serve: Residence 1Z Apartment House E] Co ercial ❑ Tra er�Court ❑ Motel ❑ tOther ❑ } <br /> Number of living units: -,/--- Number of bedrooms _-1, Number of baths /-____ Lot size --'7- _I_--- -------- 6`"C !! <br /> Water Supply: Public system ;R Community system ❑ Private ❑ Depth to Water Table ...---- ft, - <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa m 1Z Clay Loam ❑ Clay ❑' Adobe' ' Hardpan ❑ M x <br /> Previous Application Made: Yes ❑ Nom' },New Construc�ibn: YesA' No ❑­I HA/VA: Yes ❑ No; i <br /> F <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS:.' <br /> (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) <br /> Se Tank: Distance from nearest well-------------r---Distance from foundation Material-.-..-----..------.-----.-----.-----------..-_--. q <br /> No. of compartments--------------------------Size-------------------------- Liquid h Capacity S <br /> q i <br /> Disposal Field: Distance from nearest well._. b T�Distance from foundation.._- - ---___.Distance to nearest loot kine-r .-.-.. <br /> t .. �_.. <br /> Number of lines-------------- F,/--____t''__Length`of each line-______`��------a�-.Width of trench�-r.-_-___-_.__-__________. _______ O <br /> Type of filter material------- Depth of filter material ---"-_--Af-------Total length--_- ------------------------- ' <br /> Seepage Pit: Distance to nearest <br /> well Q- --'Distance from fou5clation__-.ark---_-_.Distance to nearest lot line---l6-' -._ 0 j <br /> KNumber of pits--------Z----------Lining material--. __Size: Diameter-k_/_49�C_?4.bepth--.---__l000---__----.-,---- <br /> Cesspool: Distance from.nearest well-----------------Distance from foundation-----------------_-Lining material--.--.------_-____.-_.-.-----------. <br /> ❑ Size: Diameter-------- -----------------------------Depth-.-------------------------------------------------Liquid Capacity----------------------------gals. <br /> PFivy "- Distance from nearest well'_.._`_T-N-..:`-'___ ----------- ...___"`Distance fromnearest building___r______ _________________ <br /> I ❑ Distance to nearest lot line---------r--------------- ------ ----- -----------------------------------•------------------------------------------------------ <br /> Remodelingand/or repairing (describe).-_- --------------------------------------------------------------------------.-_.-...------------------------••---------------------------------------- <br /> ----------•----------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------_--..... -------------------•--•------------------------------------•----------------------------------------------------- -------------- --- <br /> -' -------------------------------------------------------------•-------------------------------------------- <br /> - - - by c - -y prepared Pp q <br /> I hereby certify that I have re ared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed]------------ - ------- -- ---- ----------- - ---- -------------------------- -------.-. <br /> Owner and - .r- <br /> - --•-------- -------- -- ----------- <br /> --g _ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> E FOR D PARTMENT USE ONLY <br /> 1 • <br /> APPLICATION ACCEPTED BY---- -- ------------ -- ------- --- -- ---- ------------------------------------- DATE------.<-- --—- f ------=--------------- <br /> REVIEWEDBY----==------ -------------- ------ - ----------------------------- ------------------------- ---------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-----.----•-•--•------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendatio ---------- ----------------------------------------------------------------•----------•--------•----------- --------•--•------------ ----------------- <br /> ' ---- -----z----y --rte;---.�---------- ick "— t c -------��--�----------------------------------------------------------------------------------------------- <br /> ---------------------------------- <br /> ------------------------------------------------------------------------------------ <br /> ► : <br /> ------------ --------------- - - ---------------------------------------I <br /> FINAL INSPECTION BY:..-�---------- ---------- - ----- Date —'/ ` �� <br /> r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Sfreef' 814 North "C" Street <br /> Stockton, California -Lcidi, California Manteca, California Tracy, California <br /> E5- x- <br /> 9-2M Revised 8-'59 F.P.Co. %_ <br />