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' APPLICATION FOR SANITATION PERMIT Permit No. .1______.....__Z..,1._ <br /> Duplicate)in Du q <br /> (Complete P� ) Date issued <br /> 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 /> 1�44Thisyapplication is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------ ---r- e----------------- --c"J--=-------- ------------------------------------------------------- <br /> ~ '� -a Phone <br /> Owners Names w �� <br /> ► , . <br /> Address-- - z_ � - --r <br /> -------------------- <br /> Contractor's Name-------------------= ��� �° ' -<' -' --- --- Phone <br /> Installation will serve: Residence P : Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms -/--- Number of baths ___,f_ Lot size ---------- �____ ----------- <br /> WaterSupply: Public system JN Community system ❑ Private ❑ Depth to Water Table <br /> Characterr'of soihto"sidepth of 3 feet: Sand -] Gravel ❑ Sandy Loam El Clay Loam ❑ Clay ❑ Adobe, ] Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [§. New Construction: Yes ,K No ❑ FHA/VA: Yes ❑ No`F <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> k <br /> Septic Tank: € Distance from nearest well--__----�---_-__Distance from foundation_____,f0----Material----- -r_= —__-.--. <br /> �No.}ofyc`m�artme ts_________--2�------Size---- X �, -� _'__Liquid depth---------�r�-----------Capacity------ 'rte r� <br /> 4 � <br /> •it __Distance from foundation ___.Distance to nearest lot line____--_`'_.. <br /> --------- <br /> Disposal Field., Dis#ant%e,fromnearst well------ . <br /> ®" NAhber of lines------ --------/---------------Length of each line-------- +_ ---- .Width of french--------; =•rnr:-_-------------- r <br /> Type of filter material--- _Depth of filter material......A!'e _------Total length______________ ______________- W <br /> l <br /> Seepage Pit: , Distance to nearest well ____r________--------Distance from foundation____.65;_Fl.-------Distance to nearest lot line-.__._�� O <br /> [g Number-of-pits-----__ -----------Lining material.__ Diameter____`___..___Depth_..------2� ___--._____.-. <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 nearesf building----------------------------------. -_-. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------- --------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):---------- � r = ;�f: ---•� <br /> -------------- <br /> ------------ "'----------- c. P,_.. = x� 3 �.` �'—';�_ -4 &", <br /> - �- <br /> . � l h eby certify that.�i'-�iave-pse'ared-fhisEa�ication and khat the work will be done in accordance with San Joaquin County <br /> �`ord ance Sfatellaws, and rules and regulations of the San J quin Local Health District. <br /> [Signed}. k � _�- ---`------- ----------------�----------------------------------------------------- (Owner and/or Contractor) <br /> " <br /> Byl <br /> (Plot plan showing size of lot,)ocation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> `',FOR_DEPARTMENT USE ONLY <br /> APPLICA[ION ACCEPTED BY--------- -------- <br /> DATE---------- <br /> REVIEWEDBY--- --------------------------------------------- ------ -------- ---------------�---------------------------------------- DATE -----­­--------------------------------------- <br /> BUILDING{ PERMIT ISSUED-----------------------------------------------------------�- -------------- -- DATE-------- ---------------------------------------------- <br /> Alterationsand/orrecommendations:_-=-------------- --------- ------------- ------------------------------------------ ---------- ------- ------------------------------------------------------ <br /> . t -- � <br /> ._ <br /> ..,. ---------. -- - - - --t----------------------- - --•.. <br /> , <br /> --------------------------------------- ------------------------ - _ ••----•--- <br /> --------- ` <br /> -------------------I------- --------------- ------------ ------------------ -•--------- - ------------------------------------- -- ------------------------------------------ ( ----- <br /> -3 -&d <br /> FINAL INSPECTION BY:. c �� `, '' - - --------- Date- <br /> SAN JOAQUIN'LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street t -132-Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 6-'59 F.P.Co. <br />