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FOR OFFICE"U E: <br /> `". ' APPLICATION FOR SANITATION PERMIT Permit No. .1..J�...e'..._� <br /> --------------------------------------------------------- (Complete in Duplicate) / <br /> Date Issued <br /> ---------------_____________ This Permit Ex ires 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 descrbec <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND CATIO •. - ... S. r �-----------•---------........................ <br /> Owner s Name----- ------ -------------------------------------- Phone.... <br /> Address........-C------------- - 4' •------•-- <br /> Contractor's Name-------_`-A4....- �---•-----•- ------------------.r ---------...................................I........ Phone................................... <br /> Installation will serve: Residence g?Apartment House [3 Commercial vL]�Trailer Court E] Motel [I Other E] <br /> Number of living units: __/___ Number of bedrooms E- Number of baths J... Lot size ............................ <br /> Water Supply: Public system ❑ Community system.,[-] U3-15epth.to Water Table _Aleft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gra'el;t] Sandy Loam 0 4Clay Loam ❑ Clay❑ Adobe[ZYHardpan ❑ I <br /> Previous Application Made: (If yes,date___________________`) No'M,;-�Iew Construction: Yes ❑ No k4- FHA/VA. Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic tank or cesspool permitted if pubhe;sewer is available.within 200 feet.) <br /> Septi� Tank: Distance from nearest well..........;:".Distance from found ion___________________.Material.........___..-______......................_....1. <br /> r <br /> ........ Size----------------=`---• Liquid depth--------------_---------Capacity......-•--............ <br /> Disposal Field: Distance from compartments <br /> well-_r <br /> p s_..�_--._Distance from foundation.....> _......Distance to nearest lot line.......... <br /> �— Number of lines______'_________________ Length of each line___._— - __------Width of trench___rs2__r------------------------ <br /> Type of filter materia{._ ____ Depth of filter material_____ --______._._Total length______ _ ... <br /> Distance to nearest lot h <br /> . � <br /> "VT <br /> Seepage Pit: Distance to nearest well---/_f-��._�___Distance from foundation_.s' 4?. <br /> __. ne.. �... <br /> Number of pits------l_...........Lining Size: DiameterDepth_...-d`.' _________________ <br /> 5 Ces❑spDol: Distance nearest well-___--_ -_ tce from foundation <br /> undanon-------•-.-•-------.Lining material------------------------------------- <br /> " " <br /> -----------•------••................" A \"""111111' <br /> Size: Diameter - rDepth y -- - <br /> Privy: Distance from nearest well------_----- <br /> ----------------__.-------- __,=.,:,Distance from•nearest building___________________. <br /> ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------•............................................ <br /> r <br /> Remodeling and/or repairing (describe)---------------------. - 11. - <br /> --- <br /> ------------------------------------------------ <br /> ------------------------------ <br /> ----------------------------------------------------------------...........-------------=-------------- .-------- ----------•-•- ------•----------------------------•---------------------------------------- <br /> -----------------••----••-•--------. ---••---------------•------.._..---••-._...-------•------•-••-- <br /> I hereby certify that I have prepared this application and that +he 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 /> .� <br /> Contractor)(Signed) ---- - ---------------- -- :--:•-•------------- <br /> ...............Title)-------- � -By- ------------------------ -.... <br /> (Plot plan. showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). <br /> 1 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------- DATE---JP:-• ` --x..6_4------------------- <br /> 4 REVIEWED BY--------_----------_------------ - DATE.-------- --•----------------------------------------------- <br /> BUILDING PERMIT ISSUED.....--------------------------------------- --•-----•-----------------•------ ---�- <br /> k � DATE---------------------------a-- ----�--�--,-- <br /> l •-: - .. <br /> �-- __45Ateations and/or r �ndations:__. ----- . .... <br /> - ------------------------------------------------_-. <br /> ------•-------•-•---------------------•----•------------------------------------------------------.........---------------------------------------------------------------------•------------------------------- <br /> .Y <br /> k ---------------------------------------------------------- ----------- ------ ---------------------------------------------------- --------:-----------------------------------------------­_______________ <br /> �. <br /> FINAL INSPECTION BY:_",.)-r--- ------- Date_.__- __-___ <br /> 1 ................. .- ---..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strut 300 Wert Oak Street '* 124'Sycamori Street 405 West 9th Street <br /> Ca <br /> Stockton,California Lodi, llfornla Manteca,California' Tracy,California <br /> E6 9 REVISED 6-89 zM 6-61 ATLAS <br />