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FOR OFFICUS <br /> ----------------------wa;w_ _Aa� APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------- --- ---- (Complete in Duplicate) <br /> ­------------------ I This Permit Expires I 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. <br /> JOB ADDRESS AND LOCATION-11Y-3.. I ... ............................................................ <br /> --- .&...45"K�............. .................................. <br /> Owner's Name--- I....................----------------------------------------------------------------------------------- Phonelyi :3�7 ........ <br /> Address...........?-V_ J <br /> Contractor's Name------- ...............2cS..... ..----------•-----------------------------•--- P- -n jZ71 <br /> Installation will serve: Residence Er-7Apartment House [] Commercial E] Trailer Court [] Motel 0 Other 0 <br /> Number of living units: _L- Number of bedrooms Number of baths _._1... Lot size _,e��xjz>.o................................... <br /> Water Supply: Public system Er-Community system C] Private E] Depth TO Water Table4A.'ft. <br /> Character of soil to a depth of 3 feet: Sand C-] Gravel [] Sandy Loam [] Clay Loam 0 Clay E] Adobe(B—Kardpan 0 <br /> Previous Application Made: (If yes,date--/Yh-t---------) No Q New Construction: Yes tT'_`No [] FHA/VA: Yes [:] Nom' <br /> TYPE <br /> o0-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> n Distance from nearest well ......................... <br /> Septic Tank: -—-------Distance from foundation.JO......... Material---P�,!!� .. .. <br /> No. of compartments-----9-----------------Size......!3X.S-X_.y......Liquid depth....._.. _/-.--_..._..Capacity... .�..,.4 <br /> k-1, / <br /> Disposal Field: Distance from nearest well.................— Distance from foundation...ZA 1..........Distance to nearest lot line-------------- <br /> Number of lines-._.____lf............. P <br /> -------------------------Length of each line....'70----- Width of trench._.,�L _Kt.................. <br /> Type of filter material_"/Z_!��j----------Depth of filter material../r.0----------Total length.........9.0.......................... <br /> Seepage Pit: Distance to nearest well_____`.......:......Distance from foundation.../_Pt...........Distance to nearest lot line_6- <br /> /...... <br /> -B-- Number of pits----/---------------Lining materialJ2.oc .___._Size: Diameter---3.,?...........Depth-------�,5.............. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..................................... <br /> 0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well____________________.__..___--_..._..---_.--._Distance from nearest building------------------------------------------ <br /> C1Distance to nearest lot line-----------------------------------------------------------------------...................................................................... <br /> Remodelingand/or repairing (describe):-----------------__............................................................................................................................. <br /> .................................................................................................................................................................................................I---------------------------- <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, Sa Joa uin Local Health District. <br /> (Signed)--------------------------------------------------------------------------- ----- ---- ------------- -------------------------------------------------------(Owner and/or Contractor) <br /> w _ <br /> By:.......................................................... ------ ------- ---------------------------------(rifle)----------------------------------------------------------------- <br /> 1 0 s, �uil( <br /> buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot, location of system in relat n to w S, <br /> FOR DEPARTMENT USE ONLY <br /> - - <br /> APPLICATION ACCEPTED BY. 4--- ------ <br /> ................... DATE----- -- --------------------- <br /> REVIEWEDBY--------------------------------------------------------------------------------- ---------------------------------------- DATE............................................................ <br /> BUILDING PERMIT ISSUED-------------------------------------------------- ----------_­_ DATE.................... <br /> .* :---------------- ------------- .. ---- <br /> Alterations and/or recommendations:... -------------I ........... ------ <br /> ......... ------------------------- ---------------------------------------------------------------------.....................7................................................ <br /> ..................................................................................... --­-------- .................................................................................................................... <br /> ..........................................------------------------------------------------------1.........­...—........................................................................................................ <br /> .................................... -------------.._...--•---------- -------- -----------------------•---...........I.....---- ---------------I............................................................... <br /> FINAL INSPECTION BY:.---- ------------------------------- Date-----�.—___D�.......K$............ ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />