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to ji - I <br /> APPLICATION FOR SANITATION PERMIT Permit No. .: <br /> A61 (Complete in Duplicate) Date Issued __11% <br /> ]i This permit Expires 1 Year From Date Issued _/ /E_ <br /> V <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 Noi <br /> JOB ADDRESS AN LOCATION______ �__ .__-_____ __-- <br /> ' -----------•--•--- <br /> Owners Name-------- -11--til. .--•------- --------- -------------- ---------------------------- -------------- Phone <br /> Address _. je-------- --------- -------------- -• ------------------ -------•• --------------------------------------------- <br /> Contractor's <br /> - ------- --------- <br /> Contractor's Name--------- ----- --- ------ -- i� -----------••-•----------------------------_._ Phone -_ :'___ l _ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court.❑ Motel ❑, Other ❑ ,� <br /> Number of living units: _�__ Number of bedrooms _ Number of baths -_ f <br /> p7 � Lot size ---���----.�-��Q--------------------- <br /> Water <br /> ---------- -- <br /> Water Supply: Public system ❑� Community system ❑ Private ❑ Depth to Water Tablept-d-ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ Sandy Loam ❑ Clay Loam ❑ sClay ❑ Adobe �'nardpan ❑ <br /> Previous Application-Made:`Yes❑ No�ew Construction: Yes ❑ No ®�FHA/VA, Yes Ek-'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. # <br /> (No septic tank or cesspool permitted if public sewer is available within 200'feet.) t �' <br /> Fes. q i <br /> ti ankn Distance from nearest well-----------------Distance from foundation-------------------.Material__ <br /> No. of compartments--------------- ---------Sizel`---------------------------__..Liquid depth--------------------------Capacity----------------------- <br /> Distance <br /> ---•-------------- --Distance from nearest well._ ____._Distance'frpm,foundation__f_0--___-___.Distance to nearest lot line__________. <br /> r <br /> Number of lines--------- <br /> -- Length of each line-------s.$'Q. __r___________Width of trench-___ ___�___ _------------ <br /> Type of filter material i_. Depth of filter material----/-g'_"*------Total length--------- ___ Q__ ------------- <br /> , <br /> Seepage Pit: Distance to nearestrw.elL_/���---------Distanc rom oundation__f Q--------Distance to nearest lot line__`__________ CA) <br /> � <br /> Number of pits__' . Lining material ___Size: Diameter._. -----------------Depth-----`;0_.--________._----- <br /> Cesspool: Distance from nearest well_______________Distance from foundation--------------------Lining material __.._._________---.---..------------- <br /> El <br /> -_-_ -_.___.❑ . Size: Diameter�-------------------------------------Depth-------------------•-------------------------------Liquid Capacity----------------------------gals. <br /> F <br /> Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building_-___ - --------------------------------- <br /> -Distance <br /> -_-___________....____-0istance to nearesfi lot line----------------------------------------------------------------------- � <br /> Remodelingand/or repairing (describe]=--------------------------------------------------------- ----------------------------­--------------------------------------------------------- <br /> .% ------------ <br /> ------------------------------------------ --------------------------------------- -- ---------------------------------- <br /> .. f ` <br /> ----------------------------------------------------------------•--------- ---------------- <br /> - <br /> __________________________________________________________ ________________________________________________________ _____________________________________________________________________________________________ __________ <br /> I hereby certify that I have prepared this application and that the work will be done in.accordance with San Joaquin County <br /> i 'ordinances, St laws, and rules regulations of the San Joaquin Local Health District. -- t <br /> (Signed)--------- =r !,------ -------- . ----------------------------------------------------- - - (O ner and/or Contractor) <br /> , <br /> ,G,e��----- �fG-'-- ------- ------(Title)--. — ►- * --------------------------------------- <br /> (Plot plan, showing size of lot;location of syst n relation to wells, buildings, etc., can be placed on reverse side), <br /> ! FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---'-- --------------------------------_--•-------------------- DATE----- -------------------- <br /> REVIEWED BY----- ----------------------- ---- ---- ------------------- <br /> - --------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED = =_ ------------------------------DATE-------•------------------------------------ ---------- <br /> Alterations and/oy recommendations:.....' ------ ------- -- -j�-R�- --t�-- == ,� = <br /> b <br /> --------------------------------------------------- ---�-__ --------...--------...__..--. --•---------------------------- <br /> ..ra - _ ---------d" * <br /> -------------- --• ----------------------------------- ---------- ------ <br /> ---------------------------------- <br /> FINALINSPECTION BY---------------- ----------------------------------------------- Date------------------------------------------- ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street ` 132 Sycamore Street `� M 814 North "C" Street <br /> - d "� Y .l ,.�. <br /> > hAanteea California Tracy. California <br /> j Stockton, California Lodi, California Y <br /> F5.9-2M Revised 8-'59 F,P.Co. <br /> 1 <br />