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FOR°OFFICE USE: <br /> d <br /> � ___-. APPLICATION FOR SANITATION PERMIT Permit No. ...,. ...1 <br /> " --------------- (Complete in Duplicate) <br /> Date Issued ___:. .__. .. �✓ <br /> f ,, K . = <br /> ,, u. -, -----------"--- =This Permit Expires 1 Year From Date issued <br />}fir AppLcation is.,herebymade to the San Joaquin Local Health District for a.permit to construct and install the work herein described. <br /> This appl,lc/atio I <br /> made compli e R o nt Ordinance No. 549. . <br /> �P JOB ApD S CA ON- - •----------- " © 4r RRE ?t M <br /> Nam <br /> �® <br /> •,��wneJ � - - -- <br /> O is Ne.. ----------------------------------------- -------- ---------------------------- Phone----• •---_•-----------••---- <br /> 1 `®i r <br /> Address ............ ------------------------------------71,........................................................................... <br /> Contractor's Name ..!v..N......C?1---- -- -- �`- z^=----------------------- Phone[[T �✓ <br /> Installation will serve: Residence 92—"Apartment House ❑ Commercial ❑ Trailers Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ::Nmber of bedro . Number of baths ! __ L•ot size _.._--.---./ / __ _______________ <br /> Water Supply: Public system A�Community syste ❑ Private ❑ Depth t .Water Table �_____ ft. <br /> Character of soil to a depth of 3 feet: Send Gravel ❑ Sandy Loam Iay-Loam ❑ Clay Q Adobe❑ Hardpan [] <br /> Previous Application Made: (If yes,date____________________) No 0--lN ew Construction: Yes�Io ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewec i,�xailabla within 200 feet) <br /> j� _ <br /> Septic nk: Distance from nearest we istanc from found n _ Q Mat rlal ��-�®O <br /> T No. of compartments---------.�--=--.--Size__l....X __ _5_._Liquid depth_.... ------_.Capacify... !9Q9 (S_09L-S; <br /> Dis osal •eld: Distance from nearest ell 4�.._Distance from foundation 14.........Distance to nearest lot lin i� ->........ <br /> p <br /> Number`of I'ines.�: � � __._Length of each line_.... <br /> g ----.$Q.Width of trench________ ___ __ <br /> T e of filter materia ' • ` Tic 'length r <br /> yp' Imo. / D .Depth of filter matenal_._..� ___.._.__Total ___.,...._. <br /> Seepage Pit: Distance;tojnearest well ____-_�'Dstance from foundation__.......;� _.Duarte to nearest lot line ___-___-: <br /> ElNumber,of pits=_-- i __ ..-- .--Lining material-----------------------Size: Diameter __--.- --------Depth ____.._._.___.__---...--____-- \ <br /> Cesspool: Distance from jnearbst well ---_Distance from foundation--------------------Lining Aaterial:------------------------------------ <br /> 'El <br /> .-.-_-_-____ -------- <br /> Size: Diameter----- ) - Depth❑ t - .. p ------------------------------------------------..._­.Liquid Capacity............................gals. <br /> Privy: Distance fromynearest well -_ . .________ _-------------_------Distan e from nearest b'uilding-__.........___............................ <br /> \ 1 <br /> ❑ Distance to nearest lot line-------- -•--------- mow- - - _.. v <br /> L � <br /> Remodeling and/or repairing (describe)__________________ ___ _________ .... .. i.............. <br /> I I ., <br /> --...----•-•----•--------------•-------------------------------------------------------------------------------------------------------------- ---------- a--------•--------------------------- <br /> -----------------------------------------------•-----------•---•------------------------------------------------------------------- i••--••-•-••--- <br /> ------------------------------------------------------•--------------------------------------------------------- --------------------------...............................---------------------------...-------... <br /> I hereby certify that I have prepared this application and that the week*Will-be'-done'"in'accordan`ce with Sen Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) - ------------------------------ ` ,t C� (Owner and/or Contractor} <br /> •••-- . . (Title).,---?----------- ------------------------------------- <br /> (Plot plan, showing size Of lot, location of system in relation to wells, buildings, etc, can be placed.on-reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 1 --------------------------------------- �- fid--�. ---------------- <br /> REVIEWED <br /> APPLICATION ACCEPTED BY---------- E� ..................... DATE.....__..`..__ ._ <br /> BY----------------------------------------------------------------------------------------------------------------------------- DATE--------------•--------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-----------------------------------------------------•--- <br /> Alterations and/or recommendations:_._._ -_:__.___._____._.__ _ — --- ---`�" �-- - <br /> - ---' ------------- ----------------------•---- ------••-------- ----------------- ---- <br /> ��- 2 ~� -----..4� R /ON`s ,1_�- - 1A <br /> 1AlO:.... <br /> -•------••------------------------------•-••--•----••-•-----------•--------•-----•-------------------------•--------•----------•-••-----•-••-------------•--•---------------------•---•------------ <br /> ------------------------------­­---_------- - -•-- •- - - - <br /> - --------------- - ---------•' ----•-----•---•- -------••------- -------------------------------- <br /> - <br /> ---'--••--•--•----•--------•-----------•--•-•-••...................................•- <br /> FINAL INSPECTI Y - ------------- -- Date-------- /__..:. - - <br /> L <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT +; <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES D REVISED 8-59 2M 5-61 ATLAS , i�#• <br /> � 1 . <br /> r <br />