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FOR OFFICE USE: ' <br /> " "--.�YJ'�y APPLICATtoo FOR SANITATION PERMIT Permit No. <br /> q <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:Healfh District for a permit to construct and install the work herein described. <br /> E This application is made incompliance with Count Ordinapce o. 5 9. <br /> JOB ADDRESS AND LO 1O <br /> N �i -- ----- ------ ------------ <br /> �{ - - ------ -:. -----=--=----- --=-------- -- <br /> Owner's Name----°�.1!-------�---'-.... _ - -------.- Phone-----------------------•------••--- E <br /> Address-----. ..f ._ ` -- ---- . ... <br /> tS <br /> Contractor's Name--------------------=------- ------------ -------.------------•-------------------- ------------- Phone.... <br /> Installation will serve: Residence [Apartment House ❑ Commerciale❑ Trailer Court ❑ Motel ❑ Other E] <br /> Number of living units: __J__ Number of bedrooms 3---.Number of baths __e5,._ Lot size <br /> Water Supply. Publics stem Community system Private e th to Water Table .r6 Oft. <br /> PP Y� Y ❑ tY Y ❑ �� P <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ San y Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan F] <br /> Previous Application Made: [If yes,date-- ------- No New Construction: Yes P! N, ❑ FHA/VA: Yes Et No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> f ACapacity <br /> Septic Tank: ' Distance from.nearest well-L5-0-----"Distance from foundation___ _______________Mater4 i___ _.___.___- _________.___._______ �L . <br /> No. of compartments----2-----------------Size----d'j?J2___�._Liquid depth----..-4�'__- - .._-_...Capacity___12_q!,[° <br /> : - <br /> Disposal Field: Distance from nearest welkS.7.__-------Distance from fou �tionl___t*,°_._�... .-�-Distance to nearest tot <br /> Number of lines------2------------------------Length of each line__-_�rT �_�____.Width of trench.--9-4- <br /> --------------- <br /> od ----------Disponee filter <br /> material-/R---"-----------Total, length--- <br /> Seepage <br /> ength_. : <br /> See a e Pit: Distance ftoenear stlwlell�� �_ Depth of filmrfoundation__/Q------------Distance to nearest lot line__-.-- <br /> YP --- <br /> [� Number of pits--------�_------"_Lining material_----- ' �__.SIZe: Diameter.____-3 Depth_._ _lS_____-"_----.-_---"_- <br /> Cesspool: bistance from nearest well-............"_.-Distance.from foundation------_--_-- ----.Lining material_....___.______.__.--_____.____:___. <br /> ❑ Size: Diameter--------=--------- ----------------:Depth--------------------------------------- -------Liquid Capacity----------------------------gals. <br /> Privy: ._Distance from.nearest building---------------_-_ ____._____-_-... 7 _ <br /> ' - �— 4�1 Y ---_-.1-------------?:.<!----------------------- <br /> ----- w--------- --.._._.-._._..____.._-----__.---- %r <br /> Priv❑ . Distance to neo estelot I nle-___._..____:�_'.------J_"-.------'-----_-----�-------- <br /> Remodeling and/or repairing (describe):-------- ---------------------------- <br /> ------ -----------•-------- •"---•------------------------------------- --------------------------------------- <br /> r --------------------- ---------------------------- <br /> --------------------------- <br /> = <br /> .l hereby certify that`I have prepared this application andthat <br /> thL �ork <br /> Health beDi done <br /> c+n accordance with San Joaquin- - ----- ----- q County <br /> ordinances, State laws, and rules and regulations.of fh San-Joaquin <br /> ------------------ ---------------------------------{Owner and/or Contractor) <br /> (Signed)-------------------------- - ----------:---- <br /> f BY� =-- --- -- - -- --- - - ------- {Title) <br /> {Plot plan, showing size of lot, location of system in relation to wells, uildings, etc., can be placed on reverse side). , <br /> �- FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- - �' �------------------- ---•--------------- DATE. -`�.� '3'------ <br /> REVIEWEDBY--------------------------------- ----------- ------- - `------------------- DATE----------------------_------- ---------------------------- <br /> BUILDINGPERMIT ISSUED"_:.------------=----------------------------------------------------------•------=-------------------. DATE----------------- ----- ------------ <br /> Alterations and/or recommendations:__.__,����._._r�?"��`'-------------------------------������•--•-s=��'"-�-`--r--t�.�.�[ --------------------------- <br /> =----• . <br /> ' •---------------•---- --------------------- <br /> ----- -------- -- ----- <br /> ,,._... - ----------=--- ::----------------- <br /> rSAN:JOAQUIN <br /> ' bate----- -FINAL INSPECTION BY:---C.--�------ LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California, t Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3••63 F-I'-CQ- <br />