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FOAt, l E USE: <br /> Permit o. ._. ,�... <br /> ' APPL{CATION FOR SANITATION PERMIT , <br /> ,. <br /> (Complete in Duplicate) Date Issued .........••----------------------------- This Permit Expires 1 Year From Date Issued <br />-._.. -------------------- ------------ - <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance2with County Ordinance No. 549. ` <br /> JOB ADDRESS AIJ�I�,LOCajTIN____ ._-------9-------••------------------- -------------•------ ------ Phone----------_..._...---•--•-------- y <br /> ' --------- <br /> Owner's Name - •------ Phone <br /> /fj ...........................................•-----••-• <br /> Address..........•-�-'�--.dR�-----_-.!.k- -- ------------------------ <br /> Contractor's Name- '�-- .. Motel Other ❑ <br /> Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ <br /> Lot size _-- --•--------•- <br /> Number of living units: _j--- Number of bedrooms <br /> ---- Number of baths �_ ��:X1�..------•-•------------•-•- <br /> le <br /> Water Supply: Public system ❑ Community system ❑ Private �epth To Water Tab ------- <br /> or <br /> Clay ft-- Adobe❑ Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y FHA/VA. Yes �No ❑ � <br /> Previous Application Made: (if yes,date___--_.__-._____ --1 No [ New Construction: Yes IT'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No sepc tank or cesspool permitted if public sewer is available within 200 feet.). <br /> ti / <br /> r Matoerial- ................ .. !; <br /> Septic Tank: Distance from nearest well�0--------Distance from foundaption_.[----------- -- Capacity.._.&Ao ,O•- <br /> No. of compartments------ ___Size.__ 3_.x,5 -J/-Liquid depth__.'---------- t/ <br /> Disposal Field: Distance from nearest well �_r._.__Distance from foundation -.-•---••---"Distance to nearest lotline................. <br /> -------Len Length of each line---- ----------7-----------Width of trench___R�- ...--•---•----- <br /> Number of lines---.-------- --- g <br /> Type of filter material: . OG�f;---___---Depth of filter material__--_�--"-----------Total length____ls�` ...---------------------- <br /> Type <br /> --• --•• .... <br /> -- { r <br /> —� 4 <br /> Seepage Pit: Distance to nearest well_-�Q _____________Distance from foundation___./Q--_---.__..Distance to nearest lot line_..______..__.._ <br /> g p <br /> Number of pits----oZ------------Lining material__ -� <br /> aG -------Size: Diameter-3 De th-------- <br /> Distance from nearest well--=------- ------Dep}hce from foundation.. ----------------Liquid Capacity_.---•-------••---- ---•-g .. <br /> Cesspool: gals. <br /> ❑ Size. Diameter <br /> Distance from nearest building-----------------•-------------•--------- <br /> Privy: Distance from nearest well----------------------------- ----------- <br /> ❑ Distance to nearest lotline----------------------------------------------------------------- <br /> --------------- ------- ---------------"- -•------ <br /> Remodeling and/or repairing (describe -------------------- <br /> -------------------------------------------------------------------------------- <br /> ---------------------­­----------------------------- ------------------------------------ --------------------------------------------------------------------- <br /> -------•-------------•---------- .._. <br /> •------•---------•---- <br /> I hereby certify that I have <br /> espaed red this application the San Joaquinthat <br /> the <br /> work <br /> cal Heawill <br /> l beDis done <br /> n accordance with San Joaquin County <br /> ordinances, State laws, <br /> {Owner and/or Contractor <br /> ---- <br /> (Signed) <br /> Title <br /> By:----------------•---------•---- - - . - ' <br /> {Plot plan, showing size of lot, cation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> —_l ?¢ <br /> ---- --------------------------------------------- DAT E-•-----==F----- <br /> APPLICATION ACCEPTED ---=----------- a------ <br /> ----------- <br /> REVIEWEDBY--------------------------------------------------- ------------•-------------- ------------------------------------------- DATE---•---•-----------•----•---------------------------------- <br /> BUILDWG PERMIT ISSUED - -- -----------------•------------------- <br /> Al'terations and/or recommendations:___- --------------------------------------- <br /> -------- <br /> Date_ ------------ <br /> FINAL INSPECTION B XJOAQ <br /> SLOCAL HEALTH DISTRICT <br /> 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> 130 South American Street Manteca,California. Tracy,California <br /> -'' Stockton,California <br /> Lodi,California X <br /> ES 9 REVISED 8-59 2M 9-62 ATLAS ' <br />