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FOR OFFICE USE: <br /> ----------- .. ........ )kPPLICATION FOR SANITATION PERMIT Permit No. ...�....�`�. . .... <br /> -z, <br />--------------- �} (Complete in Duplicate) _ <br />__.___----_. _h --- --- ---------------- --- This Permit Expires 1 Year From Date Issued Date Issued [<2....�.. ` ...Z <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 LO TION........�.., ---Y'._•-• cr,/ >� 'G?.�. <br /> -•----•----------•--------•---------------•-•----- <br /> Owner's Name------------•- . -•----•--.. 67�° ---------------------------------------------------------------•-_. Phone.................................... <br /> 21� <br /> Address............................... --- .....j. - ---- <br /> , <br /> Contractor's Name ,1 '1 --- • --- -- - ----•-•-•.••--- Phone........-- <br /> Installation will serve: Residence Apartment House 171Commercial E] Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ....AKumber of bedrooms _, ?. Number of baths .,f.____ Lot size _.74�X.11.6_0---•-.---------•--•---. <br /> Water Supply: Public system 16V, community system ❑ Private ❑ Depth To Water Tablect�4 ft. <br /> Character of soil to a depth of 3 feet: Sand 171 Gravel ❑ Sandy Loam E] Clay Loam ❑ � Cl y [I Adobe®/F-lardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No 9 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well___,5U..... <br /> Distance from foundation-/................Material..... ............ <br /> No. of compartments____rr- ------------Size_____`]6,J(.__yG2,_-.Liquid depth._...,/ -------Capacity.....,�s: ..._ <br /> Disposal Field: Distance from nearest well-5Z...... <br /> Length of each line___ Width__Distance from foundation_...,/�_ .__.Distance to nearest lot line..5 ...... <br /> �-•----__-- <br /> Number of lines------------- __ __ Wi r <br /> -- g of trench.__c7_}<..1................ <br /> Type of filter material._ al:r~-jecckbepth of filter material__ ---d._`_ -------Total length...,1!TCU_­-----------.......... <br /> l J <br /> Seeps Pit: Distance to nearest well-----/B�-_--_-Distance from foundation...1.�-_••......Distance to nearest lot line..,.......... <br /> Number of pits-----�-----..____-Lining material__�?.S_-_1<__Size: Diameter____,�:„3_/_!..__.Depth_,.�?S_!................. <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 building-------_-_---__-____-_-_---__-..-___-_-.-. <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------------•---•-----------------•------------------•---------------- <br /> Remodeling anr pairing (describe) = ,.�/� - <br /> . . ,�. -. .�.-- -------- ��- <br /> -..� ------------•----- --------------- <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 law>and rules and ulations of t San Joaquin Local Health District. <br /> (Signed) O ------- ------------------------------------=---------------------------------- ---(Owner end/or ontractorJ <br /> • Title /� <br /> By•-•------.•----•........•. - --- ----- ---------------------------- --- ( • ) -�✓ -- - - <br /> (Plot plan, showing size ot, location of system In relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- - ----- --------................................ DATE... " bra --------------- <br /> REVIEWEDBY-------------------------------------------- ------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED..............................................................- f <br /> _ DATE - <br /> a <br /> Alterations and/or recommendations:.-.-_- f-------- -------` �`, .� ---- __ V � Z�% � ,1�--�<Y.<2 <br /> ---------------------------•--------------------------------------------------------- ------------------------------------------------------------------•---------------------•--------------•- .......................... <br /> -----•-------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------- <br /> --------------------------------------------------------------------- ------------------ ------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:..__. �__. ____.___ Date../. __.-_9_. <br /> -- ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Strout 124 Sycamore Strout 205 West 9th Strout <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />