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FOR OFFI gE �SE- <br />A <br />- <br />-------- <br />---------- <br />3z�> APPLICAT]ON FOR SANITATION PERMIT <br />Permit No. <br />------------------ ------ --------------------- (Complete in Duplicate) Date Issued <br />---------------------------- - - - This Permit Expires 1 Year From Date Issued <br />-------- ------------ <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal; the work herein clescrobed. <br />This applicatiori is made in compliance with County Ordinan -No. 549. <br />---- - --- ---- <br />J, <br />JOB ADDRESS AND !L ------ ----- - --- -------- - ----- - --- ------ <br />,5CATION _ ----------- -- ------ <br />------- Phone .................................... <br />-- ----- ---- <br />--- ---- -------- <br />-- -- -- --- ------ <br />7 W I -4s ---------------- --- ------------- <br />Owner's Name -------- <br />Address ------------------- ---------------­----- -­--------------- ­------------ --------- ...... --------------------------------- --------------------------------------- <br />----- Phone -.14r.. ------- --- --- <br />Contractor's Name_ -- C <br />---------------------------------------------------- <br />------------- I --------- <br />Installation will serve: Residence (1-0 -Apartment House [].ZCommercial [3 Trailer Court [] Motel Ej Other 0 <br />I- ------------- <br />Number of living units; -./-- Number of bedrooms _'-�Z�_-umber of baths Lot size <br />Water Supply: Public system El Community system [I Private %__Depth to Water Table <br />Character of soil to a depth of 3 feet- Sand Ej Gravel Ll Sandy.Loam Lj,_Clay.Loam [3_Clay F]_e',rA AdobHardpan C1 <br />A ❑ MA/VA: Yes C] No E] <br />Previous Application Made: 'flf Yes, date --------------------1 Noew Construction: Yes;Eg—No <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(Na septic tank or cesspoolpermitted if.pojec sewer is available -wit in 200 feet.) <br />I•I . from "foundation__________-'/ -5�,t-.'.Klaterial ----- <br />Septic Tank: nearest well- __._-I:-._. --------------- <br />Distance from I-- Distance-' <br />W <br />-------- Size-11-.9depth--------------Capacity-_----c_91f II!A <br />- ------- --- <br />'n�ts -7 7-�� ---- �___Uquid X�? .. <br />No. of cor�nparti­A --- .001 <br />/'AT._0"Dista4nce to nearest lot line___. ---------- <br />.. <br />Distance from D sf ance Vro�rfoundation_ <br />Disposal Field:- neatest well--- .9= - "i"r/ <br />X�!trench____-- 4e ----------------- <br />Number' of lines ----i------_ Length of each line__- -- cQ_ <br />------ Wiclih of <br />Type of filter r ­77-iotal't length----- 4:709 -------------- (Z> <br />I' �,e ...... -/ ------------- --- ---- <br />riaf material-_ Depth of filter meferia ----- <br />Distance fo nearest well, �e from foundation ---- lrg�� 6 est lot line ----------------- <br />---- Disfanc istahce to near <br />e <br />Se e Pit: Number of pits ---Linin j - m'ateria1__RP:1P -------- <br />-- ------ S�ze: Diameter ---- �tfft5 ........ Depth --------- <br />----- ------------- <br />----- Linin <br />Cesspool Distance from nearest well -----------------Distance from. oundafion g material----_--_____-----__.---_--_---------. <br />i------- gals. <br />Size: Diameter------------------------ -------- --------••---'---•---------------------- <br />------------- Depth-..LiIqt1id Capacity -------- 7� ---------- <br />from nearest;Llcling -------- 4 --------------------------------- <br />Dis6ce from nearest well -.._-__---__---__'____ <br />Privy-. <br />----------------- ----- -- <br />------------ ------------------------------ <br />----------­----------------- <br />Distancefo nearest lot line__. --------------- ------- <br />T <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br />be): - -------------- -------------- ------------- ------_------------------- ------------------------------ <br />Remocle�ing and/or rep'6*i'3�9(descri . � w- <br />!.04 ------------ --------­------------- :: ----------------- r._- ------------------------- ---------- ­--------------- <br />------------------------------------- ------- --------- ---------------- <br />----------------------------------------- --------------------------------------------------- <br />----------------------------------------------------- ---------------------- ----------------- ------- <br />--- ----------------------------------- -------- <br />---------------- - ---------------------------•----------------- <br />------------------------------------------------------------------- fl <br />r <br />I hereby certify that I have prepared this 2ipplication-and that the -work will. -be done in accordance with San Joaquin County <br />til ordinances. State laws, and rules and regulations of the San Joaquin Local H -alf6h District. <br />-kSgRaEfft2Vor Contractor) <br />----------------------- �C <br />---------- <br />rte'.... ... .... <br />----- - ------------ (Title) ---------- ------------------------------ ...... --------- <br />(Signe -------- --- - _. Sk <br />By: ----- -------------- ------------------------------------------------ ---------- ----------- ------- <br />ion buil in <br />Plot Ian, showing size of lot, location of system in rely on to wells, . Is, bu il . mg's, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />DATEA0 ------------------------ <br />APPLICATION ACCEPTED BY---------- --- - - -- -- ------------------------------ --------------- <br />----------- DATE ------------------------------------ ----------------------- <br />REVIEWEDBY_--- --------- ------------------ --------------- ----- -------------------------------------------- TE <br />DA----------------------------------- ------------------------- <br />BUILDING PERMIT ISSUED -------------------------------------- --------------------- <br />4: <br />Alterations and/or recommendations-----------------_---------------------------------------•=------------------=--------------- -------•------------------------------------------------------- <br />- <br />-- <br />-/--- --------------------------------------- <br />--- <br />--------- <br />--------------------------------------------------------------------------------------------------------- <br />- <br />--------------- -------- <br />-------------------------- ------------------------------------ -------------- W ----- ------- ------------- ---------- <br />-iZ7- , - _. . - 0 ---- --------------------------- ------------ I - <br />----------------------------------------------------------------------- <br />------------------------------------------------- ------------------------------------------------- <br />------------------------- <br />FINAL INSPECTION BY ----- ---------- ------------------- ---- - --------------- Date-- <br />SAN AN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />ES.9 REVISED 6-59 "P -CO' 2W G -So <br />