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FOR OFFICE USE: <br /> ----------------- <br /> ------- -------- ----- <br /> -------------------------------------I------- ----------- APPLICATION_'FOR SANITATION PERMIT Permit No. <br />-------------------------- ----------------------=M:r . (Complete in Duplicatel Date Issued --- <br />---------------------------------------- - -------------- <br /> This.Permit Expires I 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 made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIONJ3 ---- ------- .. <br /> ................. <br /> --------------------- <br /> Owner's Name-- <br /> --- --- ---- -- ---------- ------------------------------------- --------------------------------------- Phone...-------------------------------- <br /> Address_.214�_-_f V... ----------- <br /> ---- - ----------------- ------------------------------------------------------------------------------------------------- <br /> Contractor's Name- ---------- - --- ----- <br /> -------- -------- ----- -- <br /> ---------------------------- Phone-----_------:-------------------- <br /> Installation will serve: Residence [Apartment House E] Commercial E Trailer Court E] Motel E] Other [:1 <br /> Number of living,units: -A--- Number of bedrooms ---2_- Number of baths.4----- Lot, <br /> size Xj�o----------_---------- ------------ <br /> Water Supply: Public <br /> .system @3--Community system [I :Private 0 Depth to Water Table __ _aft. <br /> Character of soil to a#depth of 3 feet:, Sand C] Gravel [] Sandy Loam E]- Clay Loam F] Clay F] Adobe 2EI"Hardpan ❑ <br /> Previous Application Made; (if yes,date------ -------) No � New Construction: Yes No [F" FHA/VA: Yes Ej No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu61ici"sewer is available within 200 feet.) <br /> Septi k Distance from nearest well-------------------Di4ance from-foundation............. ----Materiai--------------------- -------------------------- <br /> NJ. of compartments--------------------------Size------------------------------Liquid dep'.fh-----:------------I.." . Capacity----------------------- <br /> t N1. - <br /> Id- ------- m oun - ----- e <br /> DispvdFig Distance from nearest well---—------Distance from f- dation---1A------- Distance to nearest lot lin <br /> 0"W Nu mber of lines-------I Length of each __`.____-----z---,-Width Width of french__,v�X_ <br /> -------------- ----- <br /> Type of filter materia Depth of filter material--_4_$1.""-_J----.Total"I length------- + __-".---t 2- ----- <br /> Seepage Pit: Distance to nearest well-___"..."""—-----------Distant ,Aom fou6dation <br /> --- ----------------Distance'to.nearest lot line___'15---------- <br /> Nu I mber of pits---1_=---------------Lining-mate ze: Diameter-----,73..-"-----_Dthep ----PZj-—------------------- <br /> ir t ISi <br /> - i 0 <br /> Cesspool: Distance from nearest well-----------------Distance4rom '.tound: ation-------------1--.1ining material--------------------------------------- Ildn <br /> ElSize: Diameter--------------------------- ----------Depth----------------==----#--- - ------ ------------=-----Liquid Capacity----------------------------gals. <br /> ''Privy: Distance from-nearest well____----------------------------- A Distance from 'Inearesi building------------ ----------------------------- <br /> El Distance to nearest ]of line---------------------------------4------------- --- <br /> -- -------------------------------------------------------------------------- ------------- <br /> Remodeling and/or repairing (describe):--------------------------------:-----------4 <br /> II----11-----------------------------------------------------------­­-------------------------------------- 0 <br /> ------------------------------------------------ --------------------------------------------------------------------------------------------------------------r-------------------------------------------------------------- <br /> --------- -----------------I--------------------- ---------•-----------------•------------ •-------•--•------------------ - --I------------------------------------------------------i---------- <br /> ---- ------------------- -------------:---------------------------I--------------------------_- •----------------------------------------------------- --------------------------------------------------- C) <br /> I hereby certify that I have prepared this applicafio'n and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, 9nd rules and regulations of the San J aq6uin Local Health District. <br /> (Signed)------ --------------------- <br /> ---------------- -- ----- --- ------- .......... -nd/or Contractor) <br /> .................. ........ ----(Ow*op-a <br /> By:--------­-.1-w-c-25 L------------ ---------- ----------------------------------------------------------------------------(Title).----------------- ----------------------- - -------------- <br /> (Plot plan, showing size:of lot, location of system in relation to wells,.buildings, etc., can be placed on reverse side). <br /> A FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------- DATE- <br /> ------------ -------/9 ---------- -- <br /> ----------- --------------- ------- ------------ <br /> -•------------------------------------------- DATE----- -----------------------------------— - <br /> REVIEWED BY-------------1 /5- <br /> BUILDINGPERMIT ISSUED------------------.---------------------:----------------------------------------------------------.DATE----------------------------- ------------------------ <br /> Alterations and/or recommend tions:--_----- ---------------------- -------------------- <br /> ea- <br /> ------------------------------- ----------------- ----------------Z.//-- 7 / 6 <br /> ----------- - -----!�7---------- ------------ <br /> ----------I----------- ---------------- __A------------- ------------------------------------------------------------------------------------------------------------------------------- --------- <br /> -------------------__--------------- ---------------- ---------------------------------------------------------------------------------------------_-------------------------------------- ------------- <br /> --------------------- <br /> -------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------ <br /> Date <br /> -FINAL --- <br /> FINAL tINSPECTION BY.:...""" {_--"-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak.Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 REVISED 8-59 3M 3-'63 F.P.Co, <br />