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FOR OFFICE USE: <br /> -___ ' _/__ _ �.�r___ APPLICATION FOR SANITATION PERMIT Permit No. . <br /> ---------- <br /> (Complete in Duplicate) <br /> --------- - -- // <br /> ___.._____________________ ------------------ This Permit Expires 1 Year From Date Issued <br /> Date Issued ___. _.�P...�_ <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 <br /> /County Ordinance No. 549. <br /> JOBADDRESS AND LOCATION------.. / ....... - - - ------------•----------------------------------------------------------------------••--•----------------------- <br /> Owner's Name- ------�.o — ------•-•-• --------------------•-----------.----------- ----------- -------------------------- Phone.................................... <br /> Address i <br /> Contractor's Name.. ---------------------------------------------------------------- Phone................................ <br /> Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ <br /> g �__ - ooms.,,,�.:. Number of baths ..�_-_ Lot size •�P.X.-_. fpe <br /> Number o 'living units: __.. Number o� be �� <br /> Wafer Supply: Public system E] Community system E] Private �epth to Water Table ,40ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8-lHardpan ❑ '- <br /> Previous Application Made: (If yes,date--------------------) No g?"New Construction: Yes ❑ No @�O'FHA/VA: Yes g3'" No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public;ewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_._9i , _Distancg,from foundation---- --•....MOtriaL. _° ._...._... <br /> No. of compartments . ____ :_Size_ .. t � __._Liquid deph__._ _l ._____.__7 --_ <br /> Capacity—.400 ------ <br /> Disposal Field: Distance from nearest well.-A�e _Distance frorn foundation.. ... __..._---_.Distance to nearest lot line-to-17, <br /> Number of lines------vZ__.------.--__ 'Length of each line_ <br /> II�-�/--____. :� Width of trench ,I ---------------------- <br /> Type of filter material--Z <br /> of.jilter material__---------------Total length.._�:rte <br /> Seepage Pit: Distance to nearest well .—W --:6_Distance from foundation....4�%.`..Dist�ce to nearest lot line..4'7.1 .. <br /> 40 <br /> Number of its._. ,r. _ --.Size: Diameter �,__� . _ .-t <br /> [�'' p' �_____. _.__._Lining materialya�i��__ s? _. _____Depth_v��J .__,e+J�f,� <br /> Cesspool: Distance from nearest well_.:-___ ___.._Distance from;foundation---------':----------Lining material__----------------------------------- <br /> 1771 <br /> _________ ____________---,-•❑ Size: Diameter---------- - -----Depth----- ---I--------------------------------------Licluid, Capacity----------------------•-----gals. <br /> I ' 3� <br /> Privy: Distance from nearest well-----------------------------------­---'�_-:_-Distance from nearest building---11__ __-_-__. ----------------- <br /> ❑ Distance to nearest lot line ------ ---- :... .---------- <br /> -------------------------------- <br /> ----- t" <br /> Remodeling and/or repairing (describe): <br /> ------------------•-------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------- -- <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 the San Joaquin Local Health District. <br /> - <br /> (Signed) G G�'---�elafiion <br /> -- (Q /or Contractor) <br /> By: .00 lr+le) - = - <br /> (Plot plan, showing size of lot, location of system ' wells, buildings, etc., can be placed on reverse side). <br /> FQR DEPARTMENT USEONLY <br /> APPLICATION ACCEPTED BY------- 1C -�''� DATE <br /> REVIEWEDBY----- ---------------------------------------------- -------------- ----------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED---- ----------------- ------------------------------------— --- --- <br /> ' � - - DATE--------------- t- --------. --- - <br /> -, <br /> Alterefzo <br /> n and�or.[/recommen'-dmatiossns- ---- <br /> .ri <br /> J -- -- " --'', <br /> �Z - J- - --------------- ----- -- __._ <br /> ------------------ <br /> --------- --------- <br /> •-------•-------•------------------------------------ <br /> --•------------- -------•- -------------------.._... ------------••-----------------------------------•----------------•--------- --••-----•------------------••-----••--------------- --• ---------•-- <br /> / � �--/ <br /> FINAL INSPECTION BY:..`-.-. ------��'�.-�-------------------- Date-------------------- ------------------------------------------------ ......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:elten'Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S-S9 3M 3-'63 F.P.DD. ' <br />