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FOR OFFICE USE: <br /> 71/- a-11 <br /> .__ ________ _ ------ _ --_-__._- -------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> --- --- ---------- ---------���--0---- --- This Permit Expires 1 Year From Date Issued <br /> Date Issued ../ j:.. . <br /> pplic tion 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 =' ----------o-11,4174_ ------- <br /> Owner's Name......odfloloy...........-r wx" ------------------------------------ ----------•....... <br /> Address.................................C5 11 1. <br /> Contractor's Name-------s _r - ! i2tti 1 -----O'Cr a/✓L('----—rV.0.............................. Phone_,O ..Oelp ° <br /> Installation will serve: Residence CK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .1---- Number of bedrooms ---2-- Number of baths I... Lot size ....4''t9_......X...../0.0.!.................... <br /> Water Supply: Public system ("eft Community system ❑ Private ❑ Depth To Water Table 1© ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Nr Clay JN Adobe,® Hardpan ❑ <br /> Previous Application Made: (If yes,date-----_--------------) No,® New Construction: Yes ❑ No & FHA/VA: Yes ❑ No-V <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 /> _.._______._. <br /> ❑ No. of compartments-------------------------Size--------------------------------Liquid depth--------------------------Capacity-------------•-•-•--•- <br /> Disposal Field: Distance from nearest well_NON,,47Distance from foundation..../40..r_......Distance to nearest lot line.....s�...I.... <br /> Number of lines............/--------------------Length of each line.......... ............Width of trench......... _'__... <br /> Type of filter material..J�0i�----------Depth of filter material....._.8��.....Total length......................../11-^_'__..._._..... <br /> Seepage Pit: Distance to nearest well__/1✓eN __Distance from foundation.....2er. .__..Distance to nearest lot line_________________ <br /> � <br /> r--- <br /> CK Number of pits......../-----------Lining material---- b�k-----Size: Diameter.......%V....__.Depth------------Add'_.__...... y <br /> Cesspool: Distance from nearest well.................Distance from foundation-------_------------Lining material_-_------:-•--_•-__---_----.-_--.____ <br /> ❑ Size: Diameter -------•---Depth----------------------------------------------------Liquid Capacity----------------------------gals. t/ <br /> Privy: Distance from nearest well ----____________________________________-------Distance from nearest building----------................................ <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe):-------.,4X.0-----7-r---- C.rT`/r.FZ!/✓�_...__� .x.................................................. <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-----X�--ryl....: pet t. --•--- -----------------------------------------------(Owner and/or Contractor) <br /> By: Ga ------------------------------------------------------- Title......... <br /> (Plot plan, showing size of lot, location 6Tsystem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- <br /> .__ .. DATE__.___, <br /> - --------------------------------------------- <br /> REVIEWED, BY----------:---------------------------------------- ------------------------------------------------------------------------ DATE-------------------•---------------•------------------------ <br /> BUILDING PERMIT ISSUED.................. .____.... T DATA....................................................... <br /> Alterations and/or recommendations:...........�:G_---,_. ___„ y-z - _!Z.L ...................... <br /> ------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------!-------- <br /> _. <br /> j <br /> FINAL INSPECTION BY:.-- -----•---------------------- ---------- --- Date--------------------- ......................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strout <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br />