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, FOR OFFICE USE:ili� <br /> ., ._ <br />--- - ------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. -zs---_____ <br /> -- ----------- ----------------- --------- Date Issued <br /> ---------- (Complete in Duplicate) r< <br /> ___________ I ---------------------------------- . This Permit Expires 1 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 /> g -------------------------- -----•--•r_'---------------------------------------- <br /> JOB f <br /> ADDRESS AN LOCATION ..`G�! _ ______ _ __ _ .-------.- - <br /> f� i <br /> Owner's Name------- +� �. •°'•== ' Phone. <br /> Address.. .... ......• ........ <br /> - - -------• --- � f-�--- . <br /> �G! / <br /> Contractor's Name------- �(i�7 1.. - ;- `"-- ------------- Phone......... -----------------••- s <br /> Installation will serve: Residence 9-11partment House ❑ C�mrr*cial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _:.`Number of bedroorrfs-------- Number of baths . Lot size ___ ,/ 1 .......................... <br /> Water Supply: Public system [ICommunity system ?�rivate ❑ Depth ro Water Table _ t I <br /> ~Character of soil'to a depth of 3 feet Sand [:]--'Gravel ❑ Sandy Loam,❑ Clay Loam ❑ Clay❑ Adobe @3-Vardpan [I <br /> L Previous Application Made: {1f yes,date_____--------------) No New Construction: Yes ��10 E] FHA/VA: Yes [r'Na [I i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspoolpermitfidif'public'sewer-is-available within=200 feet.]"l-- —� __✓✓ Z. <br /> Septic Tank: Distance from nearest well.,.-- Distance Ism fauhdation---��________.Material____�� <br /> I [� No. of compartments_____ �-_._.-__-___.__Size. ._ �'_.Liquid depth-___ 6./ Capacity.- 'L ..... r <br /> fir'` � �----------- - i- <br /> ,�a__._...Distance to nearest lot line.e <br /> Disposal Field: Distance from nsarrest well____:___ ,Distance from foundation.... ---•--�----• <br /> Number of lines_kJ ______ __ _ Length of each line__.. ., <br /> �- � y�� �h-~---------------•.Width of trench ------------------ <br /> Z `r e., <br /> Type of filter mate�ial�,�j4L� Depth of filter material___ ------------- length_.._ <br /> ,140-..................•-__ <br /> I Seepage Pit: Distance to nearest.well-----..- "_____Distance from fou dation__-- Distance to nearest lot line...4­­�__._ �I <br /> Number of pits------- Lining material.- PSize: Dia meter._, "_____..Depth__r.Aa�_r___.... ---------. X <br /> Cesspool: `°:-, Distance from nearest well_________________Distance from foundation-------------------.Lining material------------------------------------- <br /> Size: Diameter -------------------Deth---•------------•-------------------------------- <br /> �. ❑ { p .._Liquid Capacity--------------- 9als. <br /> - <br />!. Privy: Distance from nearest well__________________________s____._._---_-.--_-Distance from nearest building------------------------------------ <br /> F<. <br />�. ❑ Distance to nearest lot line------------- -------------------------------------•---------------------------- --••-----------------------=-------------------------- <br /> Remodeling and/or repairing (describe):------------- - <br /> r <br /> --------------------------------------------•---------------- ---•-----•----------•----------•-•-------......._�-•----------- --•--------------------------•-•----- <br /> ----•-•---------------•---------------•-•-- ----------------------------------------------_-_._-------------- <br /> ------------------------------------ <br /> ...... <br /> I hereby certify that I have ra ared this application and that the work will be done in accordance with San Joaquin County (� <br /> ordinances, State laws, and rules 'an <br /> nd regulations of the San Joaquin Local Health District. <br /> ' � or Contractor)-- --- <br /> ---------------------- a••----•..... -------------- - ---- -----SY° <br /> = <br /> {Plot plan, showing size of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). <br /> ---- FOR DE111PANTMENT USE ONLY I <br /> S <br /> APPLICATION ACCEPTED BY-- _ __ _ ----------------------------- __.r_TE_1_ <br /> --- •--•---.. DATE_! --��--�-- ------------ <br /> REVIEWED BY----------------------------- -------- DATE-._. ._.._._.. <br /> BUILDING PERMIT ISSUED•---. ----- ----- DATE------------- <br /> � '. f <br />- Ahera+ions and/or recommendations:./___ _______ __ �- ---•--•-•c _- ---.��--• <br /> erg ��-- --- -•--�_-_.. --- -- - - -- <br /> ----------___-----------------------------I------- --------------_----------__--------•- <br /> -------•-----•-----------------------------------------------------------------------•----•-------------------.---------------------------------........ --------•---•-------------------------------- --------------- <br /> ------------ ------ ------ - -•---- ---------•-• •----------------- ----------------..---...----------------••--------------- <br /> �i <br /> FINAL INSP -------- ------ e <br /> N JOAQUIN AL HEA DISTRICT <br /> 130 South American Street 300 West Oak Sir 124 Sycamore Street 205 West 9th Street- <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S-59 21A 5-62 ATLAS <br />