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FOR OFFICE VSE: i <br /> 1 <br /> ...... Permit No. <br /> APPLICATION FOR SANITATION PERMIT _...L._.!____......... <br /> --------------------:7 <br /> --------------------------- ------------------------- (Complete in Duplicate) <br /> ---------------------------------- ----- - ------------- This Permit Expires I Year From Date Issued Date Issued -1=I/r-- <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 oz LOCATION--------- ------- ------------------- <br /> ---� ----------- ................. <br /> Owner's Name------------- ---------------------------------------- -------------------------------------- ....... <br /> Address---:__.. 341-7-.Al.... . r------ .... . ------------------------------------------------------------------------- <br /> Contractor's Name---------------_- ............................ Phone................................... <br /> Installation will serve: Residence X Apartment House [I Commercial E] Trailer Court [-I Motel [3 Other [3 <br /> Number of living units:Z. Number of bedrooms c;L. Number of baths Z'L Lot size ------ ..................... <br /> Water Supply: Public system Ix Community system [I Private [-] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel E] Sandy Loam E] Clay Loam [3 Clay [-] Aclobe)!5% Hardpan C] <br /> Previous Application Made: (if yes,date____________________) No� New Construction: Yes [:I No�W` FHA/VA. Yes 0 No <br /> TYPE OF INSTALLATION 'AND'SPECIFICATIONS.- <br /> (Nlo'sepfic tank or cesspool ------ ---pe�r7,ittod if public sewer is available within 200.,feet.)— <br /> ice- ......... <br /> Septic Tank: Distance from nearest well_V_%ai&4.,Dista nce,from-foundation.— Material... - <br /> t -- Size,-- ...:F depth_____,%4�—______._Capacity...... <br /> No. of compartmen s-.-. ------- --------- <br /> Disposal Field: Distance fr8m nearest Disfane6`frorn foundation...�,O..........Distance to nearest lot <br /> Number of lines------1_141—-----------t.__!__._Length of e�6ch:lini----- .....Width of trench.__,:Af__ ................. <br /> Type of filter materia ----- ----­--­------------ <br /> iiilter length-.--. <br /> Seepage Pit: -Distance to nearest-.welI--rwr?_-L�. __-:L Distance from foundStion-mv..A Distance to nearest lot line....,l--------- <br /> Number of pits-------/__-A ...Lin ing­m�ate,_ri Diameter------3-S-----------Depth----- ............... <br /> I <br /> Cesspool: Distance from nearest well --------------Distarice from foundation...............I__Lining material..-_.__---.._________-_--___-__--....I <br /> N. -1----------9a S. <br /> 0 Size: Diameter--------- ----------------------- ---Depth---------------------------------------------------- Liquid Capacity---- <br /> p. <br /> i4- *' <br /> Privy- Distance from ne�arest well_________________'-____________ <br /> ------------------------------Distance from nearest t lbuilding------------------------------------------ <br /> Distance to nearest ------ -------------------I\, t . cl� <br /> --------------------------------------- -------11----------------­------ <br /> f <br /> Cl I ! <br /> f <br /> Remodeling and/or repairing (describe)' ---------- --- ------------------------------------ ............ <br /> i------ "-----j -�1 --------------- ...... , -------------- <br /> ---------------------------­-_-----------------------------------I - --------------------------------- -------- ---------....--•--------------------------------.T----------------------------- <br /> --------------I...........................................................................-----------------------------------•--•--•---------------------------------------- <br /> ---------------------­----------------------------------1-----------------------------------------------------------------------------------------------------------------------------------------------I.,--------------- <br /> I hereby certify that I have prepar;d this application and that the work will be don4 in accordance with San Joaquin County <br /> d ru <br /> rdinances, late a s, an les San Joaquin Local Health-District. <br /> 10 <br /> ----------- <br /> (Signed)---------- .. ............ .... ... -----------------------------­------- ------=---------------- --- (Own;f--and/or Contractor) <br /> By:------------------------------------------------- ----- `:.-----------------------------------......._--------------------------(Title)._..---------------- ------------------_ ---- -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,imfc-, can be placed on reverse side). <br /> FOR DEPARTMENT YSE ONLY <br /> APPLICATION ACCEPTED B --- ------ --------------------- DATE----------- -------- <br /> REVIEWEDBY__..`..--------- ------------------------------------------------------------------------------------------------- DATE---------------------•-----•--.._...-----...._..........--- <br /> BUILDINGPERMIT ISSUE ------------------------------------------------------------—----------------------- .............. DATE----------------•------------------------------------•- <br /> Alterations <br /> ATE------------------------------------------------------- <br /> Alterations and/or ........... <br /> il-�------- )------------2o� ------ <br /> d <br /> 11 -ML� 2 ............. ------- -------- ............... .......... <br /> ---------- ---- ---e---e.--.---- --- <br /> ............ ......... Kf-------- ------ --------- --------- <br /> -- <br /> FINAL INSPECTION Date------- --I-/-- ------------------------_---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamori Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVIStO 8.59 2M 5-61 ATLAS <br /> I? <br />