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OR OFFICE USE: <br /> -------• ------------------------------------------------ <br /> --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _....._ �1f <br /> ------------------------------------------------------ (Complete in Duplicate) <br /> ------- - --" This Permit Expires 1 Year From Date Issued 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. 1 G/, <br /> JOB ADDRESS AND CATION .�/Cd '- "G(/ l .;r�.. ....-- r...6j��/�C <br /> Owner's Name-----" <br /> -- �P�----� �='-=y------•------•-------------•--------------•------------------------------------------------------ Phone..................... <br /> Address.. <br /> ------------- ---------------------------- ------------------------------------------------•- <br /> Contractor's Name-------------------� "_..---------•""-- Phone.- �----------_/�D.Z.. � <br /> v - i <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/_ Number of bedrooms -"�- Number of baths "" ._ Lot size ._"". Q""" .................. <br /> Water Supply: Public system ❑ Community system ❑ Private 0 Depth To Water Table,;-?Q- 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 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 /> f Septic Tank: Distance,from nearest well�d"."--_.Distance from foundation.a ..........Material..." ._"""__"_--------------_ ,""'..�/ <br /> -.-Size- �-X"�..........Liquid depth....,. . .. """Capacity_.__. -- / <br />€ � No. of compartments""""""�"-_____ .� � r G• <br /> Disposal Field: Distance from nearest well-6-Q: -.-Distance from foundation. -- --.._.Distance to nearest lot line.-......Usk <br /> I Number of lines-"""__LIZ- <br /> -------------�,�-------A--Length of each line--��......,��-�----.Width of trench----:�-�--------------------- '^ <br /> Type of filter ma+erial... a.; sDepth of filter material----/-9""__"""""".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-.-.-------------_-_-----_------- �0 <br /> Cesspool: Distance from nearest well___------"---- _.Distance from foundation--------------------Lining material__----.-.-.._--.-.-----..-_--_-_----. <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid'Capacity............................gals. <br /> Privy: Distance from nearest well--------_"---------------------------------------Distance from nearest buildi6g------------------------------------------ <br /> ❑ Distance to 4nearest lafi line.__' <br /> Remodeling and/or repairing.(describ.e):___N <br /> ._., -----------------------------------------------....................................... ........................ <br /> -----------------------------------------•--•--------------_...--------------------••------------------------•--_.__ -_......_._..--••--------------------••-----------•-----------------=---•----------I--------------------- <br /> ------------------------------ <br /> hereby c ify that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances�5tat laws, and�ules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------�--- -----•- --- ..... -- -------------------- / -�-------`---------------- y1� -------------moi?_.%_.(Owner and/or Contractor) <br /> By:------------------------------------------------------ --------- v� � � 1-� "(T+1e1 ------------------------ - -------- - <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- -, = •-•---�t --- DATE---- --4 . <br /> REVIEWEDBY------------------------------• ----------------------- ----'--------------------------------------- DATE------------------------------------- -------------------- <br /> BUILDING PERMIT ISSUED-------------------------------------------- �-- - " DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:------- •-•-----• -- - \ ,v �I"..............."....... .... <br /> 1 �.. <br /> --------------------------------------------------------- -- �, �� - - .....--"---....--"-••--•--.....----•-----...--"-----------....--•--.....---•---- <br /> • - <br /> • '` <br /> •-•--•--- -------------------------- ---------------------- tr,-Y-------- .---••------------------------..._..- -------------------------------------- <br /> ------ ------ ---------------- -----•------------------------------ <br /> ��--------- <br /> FINAL INSPECTION BY:------------- Date.....- ---•---•-----------•--------------- ---------- •---------- ...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Stree <br /> { Stockton,California Lodi,California Manteca,California -"Tracy,California <br /> a i <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS , <br />