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FOR OFFICE OSE: - <br />--------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No.--------------------------------------_ <br /> o.-------------------------------------•-- ----- i <br /> (Complete in Duplicate) <br /> / l <br /> P PDate Issued -•_-!�/� A <br />-__-_.._.--.--.____________________-------------------- This Permit Expires 1 Year From Date Issued <br /> I I i <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 compliancefwith County Ordinance No. 549. <br /> f5Q S .E�c c c� CisJ <br /> c��f ��``� Z v'7_— AUT Z <br /> JOB ADDRESS AN OCATION._•_! -------------------��" � - --=---------- Y <br /> _ <br /> Owner's Name !1�'P ----r� _. ...j `: '.--� rte` �� �� Phone .. <br /> �, _. <br /> Address_ <br /> �i - <br /> ---•-•---•---------------------•--....------------------------ ----------------- ------ <br /> Address. ---------------- --------/`1 <br /> ......................... .......... Phone.2 <br /> Contractor's <br /> ----•••----•--------- <br /> Contractor's Name.' ----- --•- � �..: Phone °.U.:.� � <br /> Installation will serve: Residence-n Apartment House ❑ Commercial ❑ TrailQr. fart ❑ Motel ❑ Other ' <br /> Number'of,living units: ___.... NumbeF,'of bedrooms -------- Number of baths . Lot size ....- o?___.. '���`�-� ' <br /> . ----------• J <br /> Water Supply: Public system ❑ _Community system ❑ Private 2---'Depth to Water Table 92. ft. j <br /> Character of soil to a depth of 3 feet: .:Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [D. <br /> Previous Application Made: (If yes,date-____.______.__..-) No El New Construction: Yes-E) No HA/VA: Yes ❑ No [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within-200 feet.) ^� <br /> . <br /> ic. an 1k Distance fromnearerest.well'_=:___—__:.Distance.from foundation._.--_______________Material________..-....__.__._..........._-.........-_-_. = <br /> of compartments--------------------------Size------------------- -----.- Liquid-depth__t_.........------..-Capacity i....... <br /> .x <br /> po 'Fie d: Distance from nearest well..:------- `- -Distance from foundation....................Di"starice to nearest lot line.......r......... �3 <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench----------.-----.-._..... --------- <br /> Type of filter material----------------------- of filter material----------------------- g -- -.l--_ i_rv) <br /> -----Total length -- �-- <br /> Seepag Pit: Distance to nearest yell-/no---__,___'_Distance'�F�ma f��'oundation___&/.___.Distanc� to nearest lot line____-�'._....._ <br /> Number of pits------I/------------Lining material.. �_�-a ---.Size: Diameter--- .----------.Depth- ----.�.-----.-- <br /> Cesspool: Distance from nearest well.................Distance from foundation.-------------------Lining material___.________--_..._.___.____--------- <br /> ❑ Size: Diameter.--- • ..=_._-------------------Depth--------•-•---------••-----•----•-----------------._Liquid Capacity.......................... -gals. �I <br /> Privy: Distance from nearest well ____-___.__________________--------------------Distance from nearest buildingi �,I <br /> ❑ Distance to nearest lot line------------------------------- ----------------------••-•-----------•- •--............................................ I'.. <br /> Remodelingand/or repairing describe --------------------------------------------------------•----------------------•--•----•---•---••-•-•--•--------------•--•--------....................... . <br /> -------------------------------------------•---------- -------------------------------------...--------------------------------------------•-------...-.--------------------------------------------------------------- <br /> I_ <br /> ------------------------------------------------------------I---------- ------------------------------------­----------------------------•--------------------------------------•---------------------------------------- <br /> I hereby certi y-fh?t I have prepared this application and that the work will be done in accordance with San Joaquin C�unty <br /> ordinances, Stat laws,/and cul and r�Iltionsof the San Joaquin Local Health District. <br /> (Signed� - _:. .._... ------- ` ` •------------- --------- - --g.: ne�'and/or Contrector) <br /> sy- t (rtle) ---- ------ <br /> Ta <br /> (Piot plan, showing size of lot, location of system in re anon to wells, building , etc., can be placed on revers side). <br /> it ' <br /> FOR DEPARTMENT USE bNLY <br /> APPLICATION ACCEPTED BY---- ._ i_.._ ------------------- DATE--------j y� W" '--- 1 <br />' .. <br /> REVIEWEDBY---------------------------------------------------------------------------------------------------------•-•------------------ DATE------------------------------------------................. <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------.--------------- DATE-------------------------------------------------------------- <br /> fAlterations and/or recommendations---------------------------- ---------------------------------------------------•---•------------------•------------------------...--------...---.........---- <br /> ---••----'-------------------------------------------••--•-------•--------------------------------------------------•-•------------------.._.._..».-- ------I-------------------------------------------------------------- <br /> ---------I—— <br /> FINAL INSPECTION BY::'�_ .. .A. _._ _.-----:_-• �� J Date..... <br /> . <br /> /G <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 /> ES 9 REVISED 5-59 2M 5-61 AVL49 <br />