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vn 'a <br /> --------------------- ----------- ------ -------- <br /> --------------- <br /> - <br /> ------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------------ - --------------- <br /> ------------ ------------- ------------ ------ ---------- (Complete in Duplicate) <br /> This PermitYear From Date Issued <br /> Date Issued <br /> App ication is hereby made to the Son Joaquin Local Heal+h District for a permit to construct and install the work herein described. <br /> I � hereby I... <br /> This application i.s made in compliance with County Ordinance No. 549. <br /> A-1 b4'/1t-`A0--7 <br /> JOB ADDRESS-AND LOCATION ZS- /-7-0-L// <br /> --IN11�- <br /> Owner's Name.. 4?4�r* ----/-1 -----­--------- <br /> .........rr'cr�.,4/ <br /> -------•------ -------------- ---------- Phone <br /> Address <br /> ------------- <br /> Contractor's Name_-_-- -------•------ Other------ <br /> on will serve: Residence Phone................................... <br /> Court <br /> Installation i ------••------------------------------------------------------- <br /> Apartment House ❑ Commercial 0 Trailer E] Motel [3 <br /> Number of living units: -------- ❑Number.of bedrooms -------- Number of baths -------- Lot size <br /> Water Supply: Public system C] Community system 0 Private ❑0 Depth To Water Tabl I -------­------*------------------ <br /> Character of soil to a depth ft. <br /> Previous Application Made: (If yes,date-__--------- -------I No New Construction: Yes [I No ❑ Hardpan <br /> of 3 feet. Sand El Gravel 0 Sandy Loam Clay Loam Clay [I Adobe <br /> E) FHA/VA: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I Non <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: <br /> Distance from nearest well-1-101"D-------Distant fro i foundation <br /> 7 ---- ----------Material...A-kA,.,2� <br /> No. of compartments------;- --------*-------------------------- <br /> - ----------------- <br /> Disposal Field: _Size ----- --------------.--Liquid depth- ----------------Capacify/2- <br /> Distance from nearest well-/ ---------- <br /> -------Distancefrom founclatiOn­Aq------------Distance to nearest lot line--C. <br /> ju Number of lines--------/----•----------- ------Length o.f each line--_• a ------------------Width of trench.___3*1, <br /> Seepage Pit: Type of filter materia 4 Depth of material---jrf.. <br /> ------ °_:--_______Total length---?�o------s"__..""•_"""" <br /> ----- <br /> ----------Distance to nearest welWT-------- "Distance from foundation <br /> Number of pits------ --- ..........Dist nce to nearest lot lines-___ <br /> !e-----------Lining maferial.-Apw---------Size: Diameter--- 4F ............ <br /> Cesspool: Distance from nearest well_______________ Distance �frorn rfoundation-------------------Lining material_-__. <br /> El Size. Diameter------------z--------=,7n-------Dept h---------------------------------------------------Liuid Caacity---------------------------------- <br /> Privy: Distance from nearest well-------:--__-------------- <br /> - qp <br /> -------------------Distance from nearest building-----------I ---------------gals. <br /> f-1 Distance' to nearest lot line______________------_ <br /> emodeling <br /> ine---------------------emodeling and/or repairing (describe):___-__-._._____-____ -------------------------------I---------------­­­­--------------------------------------------- P <br /> ...................----------------------------------------------------------------------------------------------------------I---------------I---------------I----------------------------*---------I------------------------- <br /> -------I--------------I-------------------------------------------------------------------------------------------I-----------------------------------­ ------------------------------------------------------------- <br /> ------------------------------t------------------------------------------ <br /> b ------------- <br /> prepared this application and that the work will be done in accordance with San Joaquin-county <br /> I hereby certify that I have prep - <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> -(Signed)-.,------- <br /> By -------------------------------------------------(O ] <br /> wner and/or Contractor <br /> ------------------------------------ <br /> .....--------------------•--------•------••----•------- ------------------------ <br /> ---------------------------------- ie)............................................. ... ..... <br /> (Plot Plan, showinq size of lot, location of system in relation to wells, buildings, efc., can{ <br /> bel <br /> placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ ------- -- - <br /> REVIEWED By. <br /> BUILDING PERMIT ISSUED ---------------------------------- ----- DATE- -- ---------- <br /> ---------------*----------------------- - ------------------------ DATE <br /> Alterations and/or recommendations: - -- - <br />- ------------------------------------------------------------- --------------------------------------------- ------­----------------------------------------------------------------------------------------------------- <br /> ---------------------------------------- -------------4--------- ------------------------------:--------- -------I-------------------------I----­-------------I---------I--------- ---------------------------I------------ <br /> ------------------------------------------------ -------I------------------------------------------- ------------------------------------------------------------------------ ---------------------------------I <br /> ------I-----I------------ ---------- --------------------------- ----- --------- --------------------I----------- ------------------------------------------------------------I............ <br /> FINAL INSPECTION BY:.. <br /> ------------------- Dafe---1/7/Z-ej------- ----------------------------------------- <br /> 130 South American street SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Stockton,California 300 West Oak Street rnr* <br /> 124 Sycamore Street <br /> Lodi,California 205 West 9th Street <br /> ES 9 REVISED 8-59 2M 5.62 ATLAS Manteca,California <br /> Tracy,California <br />