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FOR�FISUfiE: <br />-------- - - ---------- <br /> ---------- <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ..._1. .77 <br /> (Complete in Duplicate) <br /> Date Issued ......"� <br /> — <br />---_................................_ .------ - . �– <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 /> This application is made in compliance with County Ordin_qAce No. 549. <br /> o <br /> JOB ADDRESS AN C TI ............. <br /> Owner's Name---- -- i --- ---- . •-• -----------------------------------------------------------•--- Phone-x-Z� +f <br /> Address ------------------ <br /> .G ------- --- -- - Phone <br /> Contracfor's Name . -- --- 7.-------- --- -------•------------- ------- Z�/ <br /> Installation will serve: Residence gKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .. Number of bedrooms _ Number of baths _/... Lot size ----------------- <br /> Water Supply: Public system [L]__60'mmunify system ❑ Private ❑ Depth to Water Table'y�,ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®•'''I"-iardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/VA.. Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> 44Noptic tank or cesspool permitted if public sewer is available within 200 feet.] <br /> Distance from nearest well-----...........Distance from foundation--------------------Material................................................. <br /> No. of compartments--------------------------Size.-------------------------------Liquid depth---•----------------------Capacity--------------------•-- <br /> w:i <br /> Distance from nearest well-----------------Distance from foundation-_-_................Distance to nearest lot line_.•........._.._. <br /> Number of lines---------------------------------.-Length of each line------------------------------Width of trench--_----_-...................._..... <br /> Type of filter material--- ------------------Depth of filter material-----------------------Total length....................................... <br /> Seepage Pit: Distance to nearest -ell __ ._---__--_.__--_Distance f ndation./61.._-......DIS a7nc�to nearest lot line 1/�. .._ <br /> [L� Number of pits...... , ....------_Lining materia.�- --- - -----Size: Diameter__ -----------Depth �--------------- <br /> Cesspool: Distance from nearest well.................Distance from foundation-------------------.Lining material.......---------................ <br /> .._-_ <br /> ❑ Size: Diameter--------------------------------------Depth------- --------------------------------------------Liquid Capacity-----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building......................................... <br /> ❑ Distance to nearest lotline--------------------------------------------------------------------------------------------------------------------------•----------------- <br /> Remodeling and/or repairing (describe):----------------------------------------------------------------------------•-•-•---••-------...----••-•---••-----•---------•---.............--•---•.... <br /> -----•-----------------------•-•-----------..------.-...-----••---•--------•----------•--------------------•--•-------------------•--------.-...-..---....--_------•-------------.....-----•-••------------------------------- . <br /> •-----------------------------------------•-...........................................................---------..............._-...-----•----------------•------------•--------••--------•--------------•--- --- <br /> I hereb ertify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance;, to a laws and Vrullesdqna,�regullaflrisof t�eno quin Local Health District. <br /> (Signed) �•- /.�..... . ...... -`- <br /> ------- - --- --------------------------- nor and/or Contractor <br /> By----------------------------------------------------- �.r...L y - ------------------(riifle)-------------- ----- -------------------- - <br /> (Plot plan, showing size of lot, location of system in relation to uildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> BY---j_ ------------------------------------ DATE---- <br /> - f ... <br /> REVIEWED ••................•---------- ------------- ---------------------------------------------------._.- <br /> DATE--•------•--•-------....._. <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE.............••---------------------• •-------------------- <br /> Allterations and/or recommendati s:---- ------------- --------------------------j .------. . <br /> -------•------•--------------------------------------•------------•--•--------------------------------•-----------•--•-•----.-...-------------------...1........ ... •---•--- •••... .-- ... <br /> -------------------------..........--- —------------------------------------------------------------------------­-­--------------------------------------------------------------------- -------------------------------- <br /> 14 <br /> ......................------------------------------------------------------------------------------------------------------------------------•---••------------------------------...-----....-----------..--------------•---- <br /> FINAL INSPECTION BY:.-S.J...^..- - ----- ----- ----------- Date----- -- 6-2 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB 9 REVISED B•59 YM 8-61 ATLAS <br />• �f <br />