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FICE USE: 6 <br /> ------------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------- -.�- <br /> --- -- <br /> -------- ----- ------------------------------ (Complete in Duplicate) Date Issued <br /> --------------- ---- - <br /> ---------------------------------- This Permit Expires I Year From Date Issued <br /> __3/ _../ I <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 �D LOCATION--I 7--t-*-0-d"',fo - -----641-.6,Z------------------------------------- <br /> Owner's Name-__.__ A--H-4 ------------------------------------------------------------------------------ --- ---- -- Phone------------------------------------ <br /> Address---­------------- 0-f-2 <br /> . <br /> ------------------------------ -- <br /> Contractor's z Phone. 46.32,1... <br /> Installation will serve: Residence 'Apartment House 0 Commercial F] Trailer Court E] Motel 0 Other [ZD <br /> azr <br /> Number of living units: Number of bedrooms __""Number of baths -1�Lot size ------------------------ <br /> Water Supply. Public system 9j10Communi+y system El Private F-1 Depth to Water Table Op ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F <br /> Sandy Loam L] Clay Loam El Clay ❑ Adobe B"Hardpan E] <br /> Previous Application Made: (If yes,date-- --- ---- -------) No F] New Construction: Yes B--N-o E] FHA/VA: Yes [-] No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest welIAM-L­Distance from foundation-10- -------Material_: c� - -------------------- <br /> No. of compartments---24------------------Size,.Awl"4 AV-A1--atq,id clep*---1521�-11------------Capacity. . .....j <br /> A nearest well-40Ske---Distance from found Z.—.,­ . <br /> Disposal Field: Distance from ne Ation---1­49-ir......Distance to nearest lot line___. ----- <br /> Number of lines Length of each line-- _0--40_____ Width of trench­-',-��... ... <br /> ---Depth of filter maferia -----------Total length------------------I-X-6------------ <br /> Type of filter materia] <br /> Seepage Pit: Distance to nearest well-Avt144 Distance from foundation--h9!--Distance to nearest lot line---- V- <br /> XNumber of pits---I---------------Lining mate rial.A C,-11--------Size: Diameter-.-,5.5-/1--Depth-A%r-0---------r------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material__-._-_....___:-_________--___-_--. <br /> ❑ <br /> aterial--------------------------------------- <br /> 11 Size: Diameter............­­----------------------Depth---------------------------------- -----------------Liquid Capacity--------- ----------------­gals.g <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest builcling------------------------------------------ <br /> ElDistance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodelingand/cr repairing (describe):---------------- --------------- ------------------------------------------------------------------------------------------------------------------------ <br /> -----------------------•---._...----------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and rules and regulations of the San Joaquin Loca Health District. <br /> (Signed)-------- --------------- e�--- ----- -- ----- - - - -- -CjL—---------------- ------YDvmW%iQftVdr`Contractor) <br /> By:------------------------------------------------------------------ --- --- ---------- - -----(Title)---------------i------------------------ ----- -- -------------- <br /> (Plot <br /> Title)--------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in rfelatio Aowells, building etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> Z <br /> -�700:� DATE <br /> ----------------------------------------------------------- — ------------------------- <br /> APPLICATION ACCEPTED BY-------------e(. <br /> REVIEWEDBY------------------------------------- --------------------------------------------- ------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------- ---------------------- --- --- ------------------ D TE------ ---------------------------------------------- --- ------------- <br /> Alterations and/or recommendations ------ --- ........ -- ---- ------ <br /> ------------------------I----------------------------- :x 11 -- ­- ------el 6j----- <br /> ------------- <br /> ------------------------------------------------------------------------------------- -- -------- -- ----------------------------------------------------------------------------------------------------- <br /> ------------ - -- -------------- -------------------------------------------- -- --------- ---- -- -- ---------------------------------------------------------------------- -------------------------------------- <br /> -------------- ------------ --------I - - ------ ---------------------------- ------------------------------- ------ ------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:. Date--- --------------------------------------- <br /> -- --------------- -------------- <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 /> ES 9 REVISED 9-59 3M 3-'63 F.RrEl. <br />