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FOR OFF1 E USE: 13 <br /> G ` <br /> - <br /> . .____ �_. 6- ____ a_�_U___ APPLICATION FOIA_ SANITATION PERMIT Permit No. . ..- .. <br /> (Complete in Duplicate)/ <br /> -- ----------------------------------------------------- Date issued .:.-- --•-b-�.�_ , <br /> ----------- This Permit Expires 1 YearsFfom 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. 1 <br /> This application i3 made in compliance with County Ordinanc No. 549. <br /> ` --------------------- <br /> JOB ADDRESS A D LOCATION_�.�-- - `�-�,-------- ------------ -------•- ---•- -�`-�--------------------------------------------- <br /> Owner's Name .`... = - - ---- --------- ----------- -------------=--------------------- Phone.................................... <br /> Address------------ -----------------------------------------= --• <br /> -----•-- --•----._......... <br /> Contractor's Name-- -- - -----------/•--�.1----- ---------------- ------------------------ - ---- Phone..------------•••....-- .: <br /> Installation will serve: Residence ©!Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' <br /> Number of living units: .1....'INumber of bedrooms .:'�,. Number of baths 4----- Lot size -------------------------•-------- <br /> Water Supply: Public system Ej�'.ICommunity system ❑ Private ❑ Depth To Water Table ..40 ft. :, <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0'"'Clay Loam ❑ Clay ❑ Adobe'2T'­HardpanA-0p Previous Application Made: (If yesildate--------------------} No ET' New Construction: Yes �No ❑ FHA/VA:Yes ❑ NodTYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I` , <br /> Se ank: Distance nearest well_-7ic _--Distance from.foundation__/Q...._ <br /> ._. Material— _ _ ---•--_ ----_-4._ <br /> --------- <br /> p <br /> � � �Parments_.___..: ....___... ._Sz_e____3Liquid d ' ___-_________._Capacity_._. <br /> Dis osal Field: Distance from nearest <br /> y <br /> well.''____.._Distance from foundation.-./.,D..-•......_.Distance to Nearest lot line-Z............ <br /> Number of line <br /> Type of filter m-----� - Length of each line___'�'(l7_..�_----------------Width of•trench__�_ ' <br /> aterial.�/_.,oC. -..._.._._Depth of filter materlal..�_ .`_..______.Total length------- -:- _____________ <br /> SeePe it: Distance to nearest �Ol+il .-_ Dince to nearest lot line.. <br /> Number of pits <br /> ag p ` well _Distance from foundation..//........... . <br /> �sta � <br /> ---------------Lining material_ k..Size: Diameter___-- -f�_o�_.._______.Depth-----42,5;7.-...---...... V\ <br /> Cesspool: Distance from (nearest well-----------------Distance from foundation---------------------Lining <br /> � material..-,............__--___----__--.---. <br /> ❑ Size: Diameter.i------•----------=------ -----------Depth.---------------------------------------• __--Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------_._--------Distance from nearest building--------_-------__--______--__.--_.-_-_-_. <br /> ❑ Distance to nearest lot line----------------------------------------------------------.........-------- • -----•-------------------------------------------------- <br /> 1 f� <br /> :1Remodeling and/or repairing (describe):---------------------------- <br /> •F <br /> -------- --- -----------------------------------------------------------------------------------------------•---------------� •---------._...---------------------------- <br /> y certifythat I have <br /> p e <br /> ! hereby this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations the San Joa in Local Health District. <br /> i� <br /> (Sign-- ----------•--------------------------------p--------------------- ---- ------ ---------------------------------------------•-------------------(Owner and/or Contractor) <br /> Plot r� Y: howin size of lot, Iota? Title <br /> 3B - <br /> ( p o s g system in relation t wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ------- <br /> --------------------------------- ................... DATE ... �_----- <br /> y.`�REVIEWED BY----------------------------------- ----•----------------------------------•-----•-• ---•-----------............... DATE------------------------------------------------------------- <br /> DATE <br /> ---------- ---------------------------=--------------------------------#-_.... DATE •--------------_- ------------ <br /> BUILDING PERMIT ISSUED-------------------------- <br /> - / .gimme -q----- :s:--------- ''"- -.F_" --------- ---- - <br /> Alterations and/or Fec mmend�ation �r <br /> }... -------- <br /> -------------- --...........------. ----- M---------------------------------------------- <br /> � ii <br /> ----------------- <br /> --------------------------- ..............1•-----•----------•------- -- - --- - ------------------------•-------- -----------------•------------ <br /> x�`--------------- Date f -------- <br /> FINAL INSPECTION BY:.. . .. *I <br /> SAN JOAQUIN LOCAL HEALTHY DISTRICT <br /> 30 South American Street 300 West Oak Sfreet I 24*xamore Street 205 West 91h Street <br /> tStockton,California Lodi,CaliforniaManteca,California " ' 'xTracy,California <br /> ES 9'_;rtFVt5£D 8-59 2M 5-62 ATLAS <br />