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APPLICATION FOR SANITATION PERMIT Permit No. ....�.'Z.l.. . <br /> A (Complete in Duplicate) Date Issued .___7 ; ��1 <br /> 1 / <br /> � <br /> This Permit Expires 1 Year From Date Issued <br /> ._�._.. <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 LOCATIO .... ----------- ---- -_,------- ---�o _-- -� ----- <br /> Owner's Name____________________ ''t L <br /> Address ' t 7'`•� =-- ---------------------------------•----------------...----- <br /> P..____ . 7__.__.. <br /> Contractor's Name........ .._ ...____G�x-- �s <?— (.____ <br /> ------------------------------------------------------------ Phone <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 171 Other ElNumber of living units: __/ _!i <br /> ___ Number of bedrooms _ _ Number of baths __4 !2__��7 <br /> __ Lot size -__ _ 4-r' -._3-_czer,�_--_____-: <br /> Water Supply: Public system ❑ Community system t] 'Private 5j,Obepth to Water Table .4--- ft. <br /> Character of soil to a depth of 3 feet: Sand F-Gravel ❑ Sandy Loam ❑ y Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 0-_"New Construction: Yes FerNo ❑ FHA/VA: Yes ❑ No ❑ <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..5d. stance from foundaa'�' n__(_O_!----- __.Materi I___---KV : <br /> No, of compartments___-_--.. '__._-------..Size____.�,(.3_,N_y�._Liquid depth------ _______________Capacity------g0_A:P.. _ <br /> Disposal Field: Distance from nearest well 'isfance from foundation... - --------Distance to nearest lot line-.5.1' <br /> Number of lines_________ _ _ __Length of each line____le_ __ °0 <br /> .�------��- Q .---- .. Width of trench---..�-,�----�-------------•- <br /> Type of filter material-._ ►_(/L t.G 6pth of filter material___--�_�._.__.__._Total length---------/, -___________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- <br /> 171 Number of pits------------:_._'__-__Lining material-._.___.._.__._______Size: Diameter------------------ ----Depth--------------------------------- <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 and/or repairing (describe) -----------------------------•-----------•---------------------------------------•-----•----------------•-------------- <br /> ---------------------------•-------------------------•--------------------------------.-------------------------.--------------•---------------------------------------•-•-.-.---------------.-------------------------------- <br /> -----------------------------------------•----------•-------•----------------------------------------------------------------------------------------------------------•---------------------------------------------------- <br /> I hereby certify that I have prepared this application-sand 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 /> (Sign(Si --------------------------------------------------------------- <br /> ed,)--- .____ .. ��� ----------------- ._(Owner and/or Contractor) <br /> By:----------- ----------------- ------------------------------------------------------- Title--------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> P2!FXT SE O <br /> APPLICATION ACCEPTED BY--- ------- - ----------- ATE--- ? 1 ._ 0----------- <br /> REVIEWEDBY--------------------------------------------------------------------------------------------------------------- ------------ DATE---------- -----•----------------------•---_------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ------ DATE----------------------------------------------------------- <br /> Alterations and/or recommendations------------------------------------ -------------------------------------------------------------------------------------------- ----------------------------- <br /> --------------------------------------------------------------------+} -----------------------------•--------------------------------------------------------.......................................................... <br /> ----------------------------------•---------------•----------------------------•-----------._--------.------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------- <br /> VFINAL INSPECTION BY: -------------------- Date 17-1- -6­__V--------------------------- -- <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 />