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%44LICATION FOR SANITATION PERMIT Permit No. 7�b. <br /> ` (Complete in Duplicate) <br /> Date Issued <br /> This Permit Expires 1 Year From 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 <br /> j with County Ordinance No. 549. <br /> JOB ADDRESS AN LOCATION_il� .___�, .* � <br /> ~ / f <br /> r ` _ - -----»_._..------ -"---' - -- L- ----��. � -""-_-ZG��___._---'............................ <br /> Owners Name------ • L .&4� rfc_ "ti .I s�.�` .. r----------------------------- <br /> Address <br /> ---• ----- ------ - Phone... <br /> Address------- " <br /> Contractor's Name -----------i.3��-_--------•-------- - •------------•-•-------------....................... Phone��t <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ ffTpailer. Court E] Motel ❑ Other El <br /> Number of living units: -------- Number of bedrooms -------- um____ Ner of bats ______ Lot size __ _____________________________ <br /> _42 <br /> Water Supply: Public system ❑ Community system ❑ Private l-3"Depth to Water Table*7,e-. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ey'I4ardpan (] <br /> Previous Application Made: Yes ❑ No [iNew Construction: Yes ❑ No [B'�IFHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> �Vl <br /> i , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> �p i ank: Distance from nearest well_________________Distance from foundation__-_-______-___-_-.Material___.__________-_______--__________.______-__--. <br /> - <br /> No. of compartments--------------------------Size--------------------------------Liquid depth------------ -------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------;---------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length.......................................... �y <br /> Seepage_P+t: Distance to nearest well,/('_---------Distancejr9m foundation_/CC...........Distance to nearest lot line _--______-. <br /> Number of pits----- -----------Lining material._ -. -..Size: Diameter___ __..____Depth--------- :� __-------------- <br /> Cesspool: <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 /> Remodelingand/or repairing (describe):----- --------• -------•--------------------------------------------------•-------------•-•------•--------------•-•-•-•---------------------------------- <br /> --------------------------------------------------------•----------------•------------------------------•----------------------------------------------------------------------------------------•----------------------•---- <br /> -----------------------------------------------------------•------------•---------------------------------------------------------•--------------- •-------•--------------••---------------•-------•--- ------------- <br /> I hereby ce ' that I have prepared this application and that the work will be done in accordance with San Joaquin Cou <br /> ordinances, St e Is, and rules and Fegulations of the San Joaquin Local Health District. <br /> 17 <br /> (Signed) ----= f E �- �' - '-----c-=------- - '----------------------------------------------------------------- ---------(0 ner and/ot Contractor) <br /> BY: ------------ -- ------ c =X (Ti+le) '1 -== <br /> (Plot plan, showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- ---- - -- ---- - ------- ------------------------------------------- DATE----- <br /> REVIEWEDBY-------------------------------- -------------- - ------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------•------------------------------------------ DATE-------------------------------------------------------------- <br /> Alterationsa . /or recommendations--------------------------------------------------- ----------------------------------------------------------------------------------------------------------- <br /> ----- = �' ,1--- --------------------------- <br /> ------------- -------------- <br /> -------------------------------- <br /> - -------------------- --------------------- -------­------ ,. ------------ --------------- ------------------------•------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY: Date---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 8-'59 F.P.Co. <br />