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rvlc------------------------------ <br /> ` <br /> - .. f.4I---_._".(.__--�� APPLICATION FOR SANITATION PERMIT Permit No. ...1. <br /> --------- <br /> -----~-- -------------- --------- (Complete in Duplicated <br /> This Permit Expires Year From Date IssuedSj - <br /> Date Issued ...����3Application is hereby made to the San Joaquin Local Health District for a permit to consta I( t; cork herein described. <br /> This application is made in'compliance with Co un Ordinance No. 549. <br /> JOB I�. <br /> ATION__ -""aC •--------- ----------._....-------------------------------......-............................... <br /> OwnerAsDNamSe AND LOC --- . <br /> ----- Phone------------------- <br /> Address..... -_ <br /> ----------------­......................................................IContractor's Name ---- <br /> ----------------••----------------------- Phone................................... <br /> • Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ .... Number of bedrooms __Z_ 6QI <br /> Number of baths -_�... Lot size ..................off <br /> Water Supply: Public system 6!T�_Community system ❑ Private ❑ Depth to Water Table .A�_Q ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made:!� Ilf yes,dpte_________---------- �+ <br /> -1 No New Construction: Yes [�No ElFHA/VA: Yes ❑ No [1! <br /> TYPE OF INSTALLATION jAND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 0. <br /> Sep Tan . Distance from nearest well______________--.Distance from foundation--------.. .-------Material------------..................................... <br /> No. of �ompartments-------------- - - --Size--------------•-•-----------.---Liquid depth-------- ------Capacity p tY <br /> Disp I i= Distance from nearest +ell- __ Distance from <br /> ` i foundation-_d,U_ __.Distance to nearest lot line.J. <br /> ( Numbers of lines____________ _ Length of each line-------94 --------------Width of trench------- <br /> Type -,_`_'-••---------- �y <br /> Type of filter material._..,1 ['A'_=_Depth. of filter material-_"_1�`----------Total lengfh.--------- 1� ------------------ (,�� <br /> " S i E,/ Distanc e'to nearest well-- . .-__ O ' / " <br /> � ��_-_--__Distance from foundation....................Distance to nearest lot lme.._'�_.._...___ � <br /> # Number)of pits------- _"__________Lining material � -_Size: Diameter_....__3_j__-. De th----- ...... <br /> Cesspool: Distance from nearest well-------------------Distance from foundation_____________..-__.Lining material__.--.-___-.__________..._____-_-____ <br /> ❑ Size: Diameter--------------------------------- rDepth--- •------------•-•--------------------------------Li Liquid Capacity q p tY = -•--...gals. <br /> Privy: Distance from nearest well_____________ ______ ___________...__Distance from nearest building i <br /> t ------- g-----•----•-------•--................... <br /> ❑ Dlstanc��.to nearest lot line----- °-----•--------------- ----------------•-••--------••------------•-•-----••-------------••---- <br /> I _r - .� <br /> Remodeling and/or repairing (describe):------------------------------------- <br /> ----••--------------•-------------------­--- ---------------------------------..-------------------------------••----------------•---------------•------------• ------------------•----.-•--••-------•-------•------ <br /> -----------------------------*---------------A---------------•----------------- <br /> -------------------- <br /> by certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and''rules and regulatioV of the an Joaquin Local Health District. <br /> (Signed) .......... ------------------------------(Owner and/or Contractor( <br /> $y- .... � <br /> __------.._.. j----------------------(Title)-------.------------------------------------ .................... <br /> (Plot plan, showing size of 101, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> �p <br /> FO IZ DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ryl Y = ---- - -- ---------------------------•-------------------------- DATE------ -� " �R �... <br /> ' REVIEWED BY ��-------------------- - ---- ---------._.. DATE_._...._.. > . <br /> - ------------------ -•-------------•------------ - <br /> BUILDING PERMIT ISSUED- �M--------•-------- - ---------.. DATE---•-•--_------------_------ -. <br /> AI er�tions and or r commendations:__--__---_...............""-"--""""" _ <br /> '� ' -- - - ----- <br /> ----�--- ------------ -- � - <br /> -----------------------••----------------------'!M= <br /> -•--------------------------------------- <br /> ---------- -------- =� ---- <br /> -------------------------•-- ----- <br /> FINAL INSPECTION BY:.-"-- =-.- ---------- Date--..-I��-r� <br /> r <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Strout <br /> 205 Wast 91h Street <br /> Stockton,California Lodi,California 1 Manteca,California Tracy,California <br /> ES 9 REVISED 9.59 PM 5-61 ATLAS ' <br />