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FOR OFFICE USE: �.� �' <br /> - ------------------------------------ -- <br /> --------------------- ------------ <br /> _----_--- APPLICATION FOR SANITATION PERMIT Permit No. .S...... o <br />-------------------------------------------------------- (Complete in Duplicate) L . <br /> � P P� � Rafe 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 /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.I_t Z "'� :...`. ` ___________ 4 ` - )._...._._ <br /> Owner's Name------ ------------------------------------------------•-- <br /> � �'�•<-�-Y;--[� ----------- Phone <br /> Address__ Gx r�Jf ----------------------------------------------------------- -------------.---------...•...-------....--•- <br /> Contractor's Name-.----- �u� 4� .. .................... Phone ! _ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel <br /> 0 Other ❑ { <br /> Number of living units: _ ... Number of bedrooms,_7_- Number of baths Z___ 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❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date---- ---------------] No New Construction: Yes ❑ No 2-' FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank-.„ -C, istance from nearest well___T.4 ----Distance from foundation-_._ ____ -------------_ -------A­4r-�~ <br /> i11o. of compartments---------. -----------Size__..-----_..Liquid depth__.....------------Capacity---t.r�r' � <br /> Disposal Field: Distance from nearest well----- from foundation.._____rt'.___._...Distance to nearest lot line. __.. <br /> Number of lines_____-_-__•-___k7----_..........Length of each __ _-_... Width of trench--..-_- � --------------- <br /> Type of filter ma+erial•_ E' �-____-Depth of filter material-----__/ ---._--.-Total length.....�...._�.°__f--------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line____-_._.-.__.-_ <br /> ❑ Number of pits----------••---•------Lining material-----------------------Size. Diameter----.--_------------_ -Depth---------------••---------------- <br /> Cesspool: Distance from nearest well_------.......Distance from foundation--------------------Lining material------------------------------------- F{ <br /> ❑ Size: Diameter--------------------------------------Depth----•-----------------------------------------------Liquid Capacity---------------------------gals. ! <br /> Privy: Distance from nearest well-________________________________________ _______Distance from nearest building-------------------------------I-..-_____. <br /> ❑ Distance to nearest lot line------------------------------------------•------------------•-------........._ .-.--•--------.-.-----•---•--••-•------------------------- <br /> Remodeling00 0 <br /> and or r airin (describe):_____ � -------- <br /> ------------ .. --- -- <br /> -r <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 /> ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. <br /> (Signed) --------- `x -------------------- ---------------------------------(Owner and/or Confractor) <br /> By/�--•-------------------•----•----•---- -----_-_(Title)- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ---`-- - <br /> APPLICATION ACCEPTED BY---�" --- ---------------------------••--------------- DATE - ----- / <br /> REVIEWEDBY-_•--------------•-------------•- --- ---------------------------------------------------• .---••------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---- --•---•------------------------------------------------------------•----------------------- DATE--------------------- ---...------------- <br /> �q'�, �r 4----------------------------- <br /> ��P1C%� <br /> Alterations and/or recommendations '---- - - -----------------------•--•-------- ---...... - -_ -------- -•- r` ... <br /> ----------- ............. <br /> •--••-•----------------•--------•------------------•-----..----------- -------------------------------------------------------- ---------------------.........------------------------------------.------•-------•------------ <br /> FINALINSPECTION BY--------- -------_------•--••------- ------_--------------- Date-------------------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Strut 205 West 9th Strut <br /> Stockton,California Lodi,California `" � Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-EI ATLAS <br />