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FOR OFFI 'USV; <br /> r <br /> ----------- <br /> 4. Permit No. _...- <br /> --------------------------------- <br /> APPLICATION FOR SANITATION PERMIT J� <br /> -------- (Complete in Duplicate) <br /> a. Date Issued ._... . _.6.Z <br /> _ _ __ ____________ _________.__.____._____ _-_ This Permit Expires 1I Year From Date Issued r :, <br /> Application is hereby made to the San Joaquin Local Health District for a ermit to construct and install the work herein described. <br /> This application is made-in compliance with County Ordinance No. 549 <br /> JOB ADDRESS AN LOCATIO ---� _ .— ------ ------ - - ." --------�.� -------- --------------•--••----•------.......-----• <br /> Owners '4 <br /> Name----- . ' -••-- <br /> f� %D�- t Phone <br /> r6 <br /> Contractor's Name ._. ..�/_��_. -- --- <--t---- •�"�----- - ----------------i--�---�~'c_.._. . ................ Phone .:�� ,( <br /> 1 <br /> Installation will serve: Residence ❑ partment ouse ❑ Commercial ❑ Trailer Court ❑ Mote! Other �--- <br /> Number of living units: .. Number of bedrooms Z,--- Number of baths _ __ Lot size ✓ :_. :P - . <br /> Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table-,6."_ ft. <br /> M Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe / —Hardpan ❑ �r <br /> Previous Application Made: (If yes,date---------_----------) No New Construction: Yes o ❑ FHA/VA: Yes [3 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Pptic Tank: Distance from nearest well-----------------Distance from <br /> foundation_____--. _________-Material____-_________.-______-----___.._.__________---. <br /> No. of compartments--------•-------•-• ------Size--------------------------------Li uid de th-- ----------------------Capacity--------­----­------- <br /> Dispos <br /> y. <br /> ield: Distance from nearest well_________________Distance from foundation-----------------".Distance to nearest lot line----............. <br /> �t Number oflines-----------------------------------Length of each line-------------------------------Width of trench----------------------------------- <br /> Type of filter material-------------------------Depth of filter material------------------------Total length------------------------------------------ <br /> Seep a Pit: Distance to nearest welly? ____-.Distance from f ndation./a..____....Distance to nearest�lot <br /> _ __ eter_-Ffes__ ___- - Depth of pits___ _ � Diam <br /> Ces I: Distance fiom nearest well_________________Distance from foundation <br /> Size: <br /> material-___.______--_--_-________/_____ <br /> ❑ Size: Diameter--------------------------------------Depth-------------------_ ---------------------------Liquid Capacity------ •-••--------------•-gals. <br /> Din <br /> Privy: Distance from nearest well-------------------------------__--------________Distance from nearest building_______.__._.__.____._........___..__-_--. <br /> ❑ Distance to nearest lot line <br /> line-----------•-------------------------------`--- -------w-------------•- ----------p_�---•---------•---�------------------- - <br /> R odelin and/ ng ----- e —._..._._f.__ <br /> ?�� <br /> lair <br /> teJ <br /> f <br /> �i <br /> --=--------------------------------------------------------------------------------------------------•--------------------------------------------- T - <br /> I hereby certify that I have prepared this a plication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, a d rule an re ulat' of t San 6aquin Local Health District. <br /> ....... <br /> _ (Owner nd/or Contractor) <br /> ---------------------------------------------------------- - � ------------------�(Signed). • - •--C ...... <br /> i <br /> tle <br /> (Plot plan, sho ize o o , location of system in relation to wells, buildings, etc., can be placed on raver ' side). L <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED $Y i - - --------- ----------------------------------- DATE------ <br /> ---- <br /> =�-- •- •G- — <br /> REVIEWEDBY------------------------ -......•----/ ----------------r------ --------------------------- DATE <br /> BUILDINGPERMIT ISSUED-------------_---'----------------•---------------------------------------------------------------- DATE_---------------•-------------------------------------------- <br /> F Alterations and/or recommendations:______.. .__� _______________ <br /> -------------_ <br /> ------------I--- - <br /> .. ------------------------------------------------------- <br /> ----------------------------------------- <br /> FINAL INSPECTION <br /> ±� ------ Date_... ~a ... _. _.. �..............._._.._ <br /> I BY:_-_�r.__._ __-_______ ______________ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 120 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B•59 8M 5-61 ATLAS <br />