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FOR OFFICE USE: <br /> ------------------------- ------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------------------------------------------------- (Complete in Duplicate) Date Issued --- <br /> ---------------------------------------------------------- - This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and in;tall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN LOCATION_jimow�. -.P-44a 9 <br /> Owner's Apl"s�t..Z..%.M.. �LZ .....................----------- Phone.................................... <br /> Address_.... e .............................. <br /> .............. ............. ............................ <br /> - ----------*--------------- ....... .......................... <br /> Contractor's Name.... ..... --- .......... Phone........ <br /> Installation will serve: Residence [6 Apartment House [] Commercial 0 Trailer Court 0 Motel E] Other 0 <br /> Number of living units: ....!-- Number of bedrooms -.7N b r f baths /---- Lot size ... ..................... <br /> Water Supply: Public system El Community system [I Private Depth t Water Table - <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam Depth <br /> Loam [3 Clay ❑ Adobe 0 Hardpan 0 <br /> Previous Application Made: (If yes,clate----------- No E] New Construction: Yes [3 No [3 FHA/VA: Yes 0 No [3 <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-----------------Distance from foundation--------------------Material.................................................. <br /> F1 No. of compartments--------_---------------Size--------------------------------Liquid clep�th--------------------------Capacity_-------------------- <br /> Disposielcl: Distance from nearest well__- .--Distance from foundation......i_0 ... ....Distance to nearest Colne. 5' <br /> ur Number of lines............. Length of each line....-&-0-------- "'Width of trench........:2�. r........- <br /> Type of filter mat'e rial. A�-----Depth of filter material-------Ik----- ---Total length.....Ab..........................- <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation...................Distance to nearest lot line.___.- ........ <br /> El Number of pits-----------------_...Lining material---------------------..Size: Diameter--._.-,-_._.,.._._...-.Depth-...-----.._......__._........... 40' <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.-__---_----.--_--............... 0 <br /> ElSize: Diameter-- ------------------------------Depth----•----------- ---- ------------------Liquid Capacity------------------------4...gals.; <br /> Privy: Distance from nearest well_. .-.._--_-_--__. .----_------------------Distance from nearest building:_..............__.. ........ .._..... <br /> r7lDistance to nearest lot line--------- -------------------------------------------------...........--------------------------------------------------------------------- <br /> Remodelingand/or repairing (describ -------------- ......................................................................................................................................... <br /> ...............................................................!�......... ....................11-------------------------------------------------------------------------------------------------------- <br /> ------------------- <br /> ............................................................ ..... ..... 'I................................................................----------------;----•--•---•-............----------------- <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 ella , and rules and regulations of the San Joaquin Local Health District. <br /> .................. <br /> ...... ----- ----------------------Cleorlio and/or Contractor) <br /> (Signed)....---------- ...........--------------- ------------------------------------- <br /> '5" <br /> -------- ----jw.fl, <br /> By:------------- ..... --------------- - ---­---­------------------(Title)--------------------------------------------- --- ------------- <br /> -i <br /> (Plot plan, showing size of lot, location of system in relation t buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 7 <br /> APPLICATION ACCEPTED BY.... ----------------........--------------------------- DATE----- <br /> --------------------_- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------- _--------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED..................... ------------------------------------------------------------------------------- DATE----- ------------------------------------------------------- <br /> Alterationsand/or recommendations:--_----- --- -----------------------------------------------------------...................................---•----- -------------------------•----. <br /> -----­------------------------------------------------------------------------------------------------------------------- .................. ---------------------------------------------------------------7..... <br /> ----------------------------------- ......................................................................................................................................................................................... <br /> ............................................................................................................................................................................................................................ <br /> ------------------------------­­--------------------------------------------------------------------------- ...................................................................................................---------- <br /> Date ------....-•-----------•--------------------------- <br /> FINAL INSPECTION BY:./A��_ _-_ --------------_------_--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hax*lton 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 B-69 3M 3`63 F.P.120. <br />