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! CE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. . .�7..�3 p. . <br /> -------------------------- ----------------- (Complete in Duplicate) <br /> _--------------------____________ --------__--------- This Permit Expires 1 Year From Date Issued <br /> 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 L_j-, �-Y •Z=�1 mac , ` C ..�G _+ �-i�..'.fi c <br /> Owner's Name...- '!f: - = a:-a'.- <br /> -,—s s...-------•--•-•--•-------------•-------------------•------------------------------- Phone.................................... <br /> Address................... --- <br /> Contractor's Name........................... . ---•-- .. -------------------` i.�.._ �_.... Phone............ <br /> Installation will serve: Residence [J Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: J... Number of bedrooms -*.. Number of baths .moi._ Lot size ...............la- 4-4A ------------- <br /> Water <br /> ......_...JWater Supply: Public system ❑ Community system ❑ Private [X Depth to Water Table ........ ft <br /> Character of soil to a depth of 3 feet: Send 0 Gravel ❑ Sandy UW# Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No Al New Construction: Yes [e 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.) f <br /> Septic ank: Distance from nearest well_/� ---Distance fro foundation•••!.....---.Material...... ............ <br /> ........ ..... <br /> No. of compartments----_-_ SizE.Liquid depth...........' `.__.___.__Capacity...f S .t' <br /> Dispospit,Field: Distance from nearest well..../________.'_Distance from foundation....1.0..........Distance to nearest lot line.:........... <br /> Number of lines....---....777�.... Length of each line--__.___-�-- .../.......Width of trench.........Z-- <br /> ................... <br /> Type of filter material._.. _.Depth of filter material...... 8_`_......Total length....... :...'„.w.` ...... <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..................................... <br /> ❑ Size: Diameter--------------------------------------Depth-------------------------------------- ------Liquid Capacity............................ <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line.............................................................................................................................................. <br /> Remodelingand/or repairing (describe):---------------------------------------------••---•------•---•---••••---•----•----•-•--•.......-•----...••---•------•---....---.............--••-•----- <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 regtions of the Sa Joaquin Local Health District. <br /> (Signed)............ ... ,,/. . :,C..ei----------------------•----(Awnw-V't1` 6r Contractor) <br /> By:..... ..... ------------ - - (T'itle) ........ .............. <br /> (Plot plan, showing size of lot, location of system in relation to e'Is, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.. --- --------•---•--............. D AT - ....................... <br /> REVIEWEDBY------------------------------------------------------------------------------------- 1----•-•-•-------------•--• DATE........................................................... <br /> PERMITISSUED..............................................................--.---.......)---------------------••- DATE............................................................ <br /> Alterations and/or recommendations:-------------------------------------------------------------------- <br /> •••-••-•••---••------•------•-••----•----••-----•-•-------•--------•-------------------------•••...------------------------•--•----•••-----------------•-•-------------•-•-••------•------•••-----•......----•-----•-•...... <br /> -----•------•------•-----------------------------------•----------------------------------------------------------------------------------------------------------------.................................................... <br /> -----------•-•------•••••-•-------------- ------•--•-••••--•----•'-....---------------------•-----------------------------,--.-----•--•--------•----------------------------------------------------------•--•-----------_ <br /> FINAL INSPECTION BY;O ................................... Date--lz ................................................................... <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 5-89 RM 5-61 ATLAS <br />