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FOR OFFICEUV: <br /> V-7,4Z 30 <br /> --------------- PLICATION FOR SANITATION PERMIT Permit No. _._,l`t.d....�..... <br />------- --- -- -------- -----------.----------•---- (Complete in Duplicate) �.. <br />- <br /> --------------------------------------------- This Permit Expires 1 Year From Date Issued 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. r] <br /> !2-t t9 C. Ci e•K774 S7' ' � �! j`t t�1 ; /7(--4 42_ -( <br /> JOB ADDRESS AND LOCATION Z� .. .... ''i 1------------------------------------------------------_.__...........-•-•-•---------•-------.- <br /> Owner's Name----- r.. ,eY! . Phone.. <br /> ----••----------------•-- --------•--•-------••-------••-------------- <br /> Address... /� ------------------------------•-----......................I——.--------•-----------------------------------------------------------------....---•-•--•-----•------------- <br /> Contractor's Name......, f1 -po. "-C---,75........----••------•-•------•--------•-----•-------------------------------------------------- Phone................................... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----I_ Number of bedrooms ---L. Number of baths -.151..... Lot size -______________________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe El-�Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------I No �ew Construction: Yes TNo ❑ FHA/VA: Yes ❑ No 2-'- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sepp�-A-y Distance from nearest well_________________Distance from foundation....................Material................................................. <br /> No. of compartments--------------------------Size----------------------------_Liquid depth__......----------------.-Capacity....................... -� <br /> Dispajal Fie)d.l Distance from nearest well.: ...Distance from foundation. ----- Distance to nearest lot line__ ........ <br /> cjolr �a Number of lines---------------1------------------Length of each line----------- <br /> !ti?---------------Width of trench------Lam_----.--------.•-- <br /> Type of filter material,_` _______Depth of filter material----- _._..........Total length------------ ------------------ <br /> Seepage Pit: Distance to nearest well_marK- -------Distance fromf undation____2,&.'*..___.Distance to nearest lot line._+_.V...... <br /> E9­-_' Number of pits------ '-------_------Lining material___ ----- Size: Diameter____. �1 -------Depth__-_____ �-+7_�_______.._, <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material__.__________________________________ <br /> ❑ Size: Diameter--------------------------------------Depth-----------------------.._..-----------------------Liquid Capacity............................gals. ` <br /> Privy: Distance from nearest well ______-------_----------------------------------Distance from nearest building......................................... <br /> . <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------•--•-----•----••----.............•...................._.__. 7 <br /> Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ ........................................................ <br /> --------------------—---------- -- ----------------------------------------------- .--•-------------------------------------------------------------------------•----------------- -------•-•--------------------•-------- <br /> I herebycertif-- 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 aguations the San Joaquin Local Health District. <br /> (Signed) (. Owner and/or Contractor <br /> 'g )................................... f ..!�_ .._..-----•---------------------------------------------------••----..-....• ------- { ) <br /> By:.......................•-•-•........-•--•-----�' -f------ -- ----...--------------------._--.-----------------.._.............(Ti+le) ...----------------------------------------- <br /> (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -- --- -------- -------- ------------------------------------- DATE-------3--- ... -•--------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------ ----------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------- ---------- <br /> Alterations and/or recommencratians:__� --- -I'-- ......: -------�_2..---- `-�-� -•- -•------.. ?.�. ____________________ <br /> -------•-----------------------------------------------------------------------------------•------------------.--------------------__--------•------------_------••-------•---•-----------------•----------------- <br /> FINAL INSPECTION BY:.G -.-.4 --- ... Date - ----------------• --------- . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 114 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 EM 8.61 ATLAS <br />