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L <br /> �R OFF! E'vSE: <br />--------� -------- <br /> �9APPLICATION FOR SANITATION PERMIT Permit No. <br /> I (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 rade in compliance with County Ordinance No. 549. <br /> Q •-- .............................---............ <br /> JOB ADDRESS AND LOCATION---------- <br /> - � <br /> Owner's Name ,�,c--7 ---4a.- L--�-l•---------•----------•------•------ <br /> Address-------------- * . Y-_Sko.-�---------- <br /> Contractor's Name__J.______.... <br /> _/�,,.- � -- <br /> ----•••--------•---------••---------------------•-•---•------ Phone_.?"XZ1_.__ '7.! <br /> �• --�•.�-�-- --�t--+�-�-- <br /> Installation will serve: Residence Aps;tment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 <br /> Number of living unit Number of bedroom&--. umber of baths ./... Lot size __ p_ ___.. .. - -----.----•- <br /> Water Supply: Public system ❑ Community system Private C] Depth To Water Table ` ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Appiication Made: (If yes,date......--------------) No ❑ New Construction: Yes 21""'No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_..Distance from foundation__ ._...__.MateriaL __ ___________ ________________ ________ <br /> Size. `-C_ _.` _ Li uid de th_- .---j----------Capacity---I_a p_f�_ _ <br /> �/ c� <br /> No. of compartments_.____.___- �-- �_--- q P• -••/ <br /> Disposal Field: Distance from nearest well.3�_.__._Distance from foundation�._P..-'.___Distance to nearest lot line___-�`-- <br /> ___Length of each line__, <br /> Number of lines,-----•- - g � -a- -- �'-'Width of trench-------.,) ��/--------------- <br /> �' --Total length nc �•-••----`----------- <br /> Type of filter material t - _-Depth of filter matenal--./�__________ <br /> ,{z - e Distance to nearest)of line....:.. ....... <br /> Seepage Pit: Distance to nearest well_ ___ ____Distanceom foundation__ _ _ <br /> 10 Number of pits....? ............. g material---_._-- -- -- - -----Size: biameter__ ........Depth_ �.-____••-•--•- <br /> Cesspool: Distance from nearest well__________•-_--_Distance from oundation___----------------_Lining material----------------____-__.-.._.___----- I <br /> ❑ Size: Diameter-------- -----------------------------Depth--------------------------•------------------------Liquid Capacity-------•--------- -----•----gals- <br /> Privy: Distance from nearest well--------------------_---------------------_.......Distance from nearest building--------------------------------.------_-. <br /> ❑ Distance to nearest loft line------------------------ -------------:--------------------- ...... -•-•----------------------------------------------------------------- <br /> Remodeling <br /> --•-------Remodeling and/or repairing (describe):--------------------------------- ----------------•------------•-----•------•--------•-•----------------•---------------------•---•-----------•------•- ' <br /> •-----------------------•---------------------------------•--•----------------------------------••-----------•--._--------•---.-------------•--------- --------------- f <br /> -- <br /> ------- --------- --------- --•-----•------ - - <br /> •--••-----------------•---- ------•--------------------------------•------• -------------------- -------------------- . ----•---------------------------------- <br /> that I have prepared this application and that the work will be done in accordance with San Joaquin County *" <br /> hereby certify t p p Pp <br /> ordinancesZSle law , and rules and regulations of the San Joaquin Local Health District. <br /> --.---- Contractor <br /> Signed)- , - -� _a-.' <br /> rd,l� ) <br /> rifle -. _ <br /> (Plot plan, showing size of lot, location of system in relation wells, buildi , etc., can be placed on reverse side]. I <br /> FORD PARTMENT USE ONLY <br />` - 7 <br /> ---------------------------- <br /> APPLICATION ACCEPTED BY 1 - ------ ---------------• ------------------------•--- DATE_ <br /> REVIEWED BY ----------_--- DATE----------------------------------••--••-------------------- <br /> ---------------------- ----------- <br /> BUILDING PERMIT ISSUED-------------------------- - _ DXTE <br /> ----- <br /> -------------- <br /> AFFerations end/or recommend'afions:____��-Q��_.-.--�--'-�--�•-�-�----�- • <br /> -----I-------------------- -------------------------------- <br /> •------------------------•---------­---­ <br /> --------------------------- <br /> -----------------•---------------•---­----------------------------------... <br /> Z...----------------•--_ ----------------------------------•------------------ --- <br /> ................ •.._.__...------. -•--------------------------------- --- -----------,- ---------------- -----•------- ------------ ---------- <br /> FINAL INSPECTION 8 .. - ----- Date_ ----•------------------•- <br /> d SA OAQUI LOCAL HE LTH DISTRICT <br /> r <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED U-59 2M 5-62 ATLAS s Y <br />