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OR PF IC USE. <br /> .. . .. . -APPLICATION FOR SANITATION PERMIT Permit No. .... .......... <br /> . ..... .. . .. . ------------------ -5 <br /> --------------------------- ----------------------- 1complete in Duplicate) Date Issued <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 o. 549. <br /> ,L �l <br /> JOB ADDRESS AND L ATION..........f - '. . ---- . ...•-------- <br /> Owner's <br /> ..M..... ......­­................. <br /> ---- ---------------I---------------------------- <br /> Owner's Name- ­------------- --Pho <br /> -- ---- ........M-----------------­----------- <br /> ---­----------------I----------------------------------------------------- <br /> Address------ -------->e- ­------------- <br /> Phone­-,�-v....� <br /> ----------- - ---------- <br /> Contractor's Nam&�- -"X,-- -------V------ ---- Commercial E] Trailer Court El Motel E] Other El <br /> Installation will serve: Residence g�-4partment House [I size --------747.1--- ........... <br /> Number of living units: I--- Number of bedrooms3--.- Number of baths j---- Lot <br /> Depth to Table.�-- ft- <br /> Water Supply: Publicsystem Community system El Private &1 <br /> 011com a Hardpan 0 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam D Clay Loam [] Clay El �,Aclob <br /> Previous Application Made: (if yes,date.--.------- -------) No n New Construction: Yes [I No. FHA/VA: Yes E] No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) <br /> o septic tank or cesspool permitted if public sewer is <br /> eep , --- Distance from nearest well---------------Distance from foundation-------------m-----Material----------m-----------------------------------­ L <br /> No. of compartments--------------------------Size--•---------------------m------Liquid depth­------------------m-----Capacity-------­-------------- <br /> �Velcl: Distance from nearest we[L-5-49-------Distance from founclatioo..,-Ip---------Distance to nearest lot line <br /> �f trench--- --------------- <br /> Number of lines------ ------ ---­Length of each line-------------4��Q_!_...Width c <br /> Type of filter maferia ---Depth of filter material------/�F-�i-----Total length- <br /> Seepage Pit: Distance to nearest well ------ ---Distance from foundation-4.kZ?-------­Distance to�nearest lot ine All <br /> ---------Lining material-12Depth----/ ------------------ <br /> &--/ Size: Diamefbr----2' Z-!�-0 . <br /> Number of pits.- -----------m - - i ----- -----------------Lining material <br /> Cesspool: Distance from nearest well.----------------Distance from undation-. -----------------------------------— N' <br /> 1-1 Size: Diameter—.---------------------------------Depth-------M-M---------------------------------- <br /> -------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well.-----------------------------------------------Distance from nearest building-___________._._____---_____---____-__.._. V) <br /> ❑ <br /> uilding------------------------------------------ <br /> 0 Distance to nearest lot line__._.-"-------------- ----------------------I----------------M-M-M----------------- --------------­-------M------- <br /> Remodeling and/or repairing (describe):------------------- -------------------------------------------- ----------------•---------- <br /> --M--------------------------------------------M...... -------- <br /> x--------------------------------- --------------M--------- <br /> --M -••---------•----------- -------------------------------------------- <br /> -------------- ----------------- <br /> -----------------------------­ <br /> ..------------------------ ---------I - -------- "--------------------- ----- - ----------------- <br /> -------M----------------------I--------------------------------I........... ------- - ------ ------ -'- A. <br /> --------------------------------- ------------------ ­­--- --------------------------- 7 <br /> that the work will be done in accordance with San Joaquin County <br /> I hereby certify that I have prepared this application and + <br /> 4&S J Local He th District. <br /> ordinances, S. law k, and rules �ndd regulations of e an oa9yin f <br /> — -------------------(Qfx�� Contractor) <br /> ---------------------- <br /> --------(ritle) - <br /> i lr+le) <br /> --- ----- <br /> �u ------------ ------ ------------ ------- <br /> By:-----------------------------­------ --------------------------------------------- - - -----M <br /> relat; 0 laced on reverse side). <br /> (Plot plan, showing size of lot, location of system in wells, building etc., can be p <br /> i I wells, <br /> FOR DEPARTMENT USE ONLY <br /> --- ----------M------------- <br /> APPLICATION ACCEPTED BY------ ?-=1CZ6-s----------- ----------------------------------------------------- DATE- <br /> REVIEWEDBY------------------------- -------------- --------M--------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> ------------------------------r---------m-m------------------ <br /> BUILDING PERMIT ISSUED------------ DATE----------------- ----------------------------------------------- <br /> -- ---------------------------------------------------------------------------- <br /> Alterations and/or recommendations:__._-___ <br /> --------------------- ------------------------------------------------------- -----------------------M--------------------- <br /> -----------------I-----­------------ ------------------------------------------ <br /> ---------------- <br /> ----------•---------•-•---------- <br /> --------------------------------------------- ----------------M---------------M------------------- ----------------------------------------------------------------- ---------------M------------------ ------------- <br /> ------------------------ ------------- ------- <br /> ----------------------1-------M----------------------- -------------- ------------------- <br /> ------------- <br /> --------------------rl------------ -------------------------------- <br /> ­ ---..---------------------- ----------------- -----------------------------I -----------------------------------M---------------m............ <br /> --------=7 7-- 4-7 ------------------- ---------- <br /> --------------- ----- --------------------- <br /> FINAL INSPECTION Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Well 9th Street <br /> Stockton,Califorrila Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />