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FOR OFFICE USE: 3o <br />---------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. LLS........... <br />---------- ------------------------ --- - ----- __ APPLICATION <br /> --I-- ----- ----- (Complete in Duplicate) Date Issued L_( q <br /> ----------- ---- <br /> --------- ,This Permit Expires 1 Year From Date Issued <br /> Applica- <br /> ---------------------- <br /> -Hon is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. <br /> This application is made in compliance with County Ordinance No. 549. 7 0 <br /> f -/,-* /M 4A1 Oz�- <br /> r , <br /> ../ <br /> ell <br /> JOB ADDRESS AND LOCATION <br /> I�� <br /> Owner's Name------ --------.ePhone........ <br /> -------------- <br /> tp_ ----------I---------------------- ----------------------------------- <br /> Address..........C. D,_Xeep,0 F 4-0 e# <br /> i � -------------- <br /> ---------------------------------------------*-------------------- -------------------•------------------------ <br /> Contractor's <br /> --------------*----------Contractor's < .. zs ----------------I---------------- <br /> - <br /> -----­------------ <br /> ". <br /> Installation will serve: Residence Apartment House.E] Commercial F] Trailer-Court E] Motel [] Other C3 <br /> Number of living units:,--_T Number of bedrooms Number of baths .../. Lot size ........ ...... ------------------- <br /> Water Supply: Publicsystem [I Community system El Private Depth to Water TableZe2_ ft. <br /> Character of soil to a depth of 3 feet: Sand [3 Gravel [I Sandy Loam x Clay Loam F1 Clay ❑ Adobe L] Hardpan [3 <br /> Previous Application Made: (If yes,date--------------------) INNew Construction: Yes E] No 0 FHA/VA: Yes E] No [:1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: OX <br /> (No septic tank or cesspool permitted if public sewer.is available within 200 feet.) 4b <br /> r / ----------------- <br /> Septic—Tank: Distance from nearest well_-_ ----- <br /> Distance from foundation---/Q-_-----_Material----- <br /> No. of compartments-_,?-----------------Size-1XII------- Liquid clep�h-------S-Z-------------Capacify__.1Z&__0 l__0---- <br /> No. <br /> Distance from nearest well_ -- -----------Distance to nearest lot line <br /> Disposal Field: Distance from foundation Width of french--------- ------------- <br /> Number of lines---------- ---------------Length of each line......JFD--- ----- - ------------- <br /> 9 terial----- ' --Depth of filtermaterial---- -ZR_�_.........Total length-------- <br /> Type of filter ma. p-c&, <br /> Seepage Pit: Distance to nearest well--------------_-_----Distance from foundation---- ..........7__.Di'stance to nearest lot line----_.---.-__---_ <br /> ❑ <br /> ine----------------- <br /> El Number of pits--------------.-------Lining material---------:-------------Size: Diameter------------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest-well----:------------Distance from foundation ------------------Lining material---------__---------------_--.-.----- <br /> [] Size: <br /> aterial----------z-------------------------- <br /> Size: Diameter--------------------------------------Depth---------------------_--- ------------------ -----Liquid Capacity-------------------------_-gals. <br /> Privy: Distance from nearest well------ --------------------- ------Distance from nearest building----- ----------------------- ------- <br /> Distance to neart;st lot line----------------I------------------------------ ----------I---------------------------------------------------------------------------------- <br /> 0 <br /> Remodeling 'and/or repairing (describe):---------------------------------------------------------r -------­--------------:------------------------------------------------­----------------- <br /> ---------------I---------------------------------------------------------------------------------------------------------------------------------------------------­--------­------------­­----------------------------- <br /> ---------------------------- <br /> -----------------------------------------------------------------------­- <br /> -------------------------------------------------- ------------------- ------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------:------------------------- -------------------------------------•--------------------------------------------------- <br /> I hereby certify that I haiv 7-pwre4 this application and that the work will�bi done in accordance with San Joaquin County <br /> A <br /> ordinances, State ws, and n?es and/ire gbiations of the San Joa yin Local Health Dj-if rict. <br /> (Sign ed, 4_�------ ------- •-- - - ------ -------------- ---- ----- ----------------------,- AOwner and/or Contractor) <br /> LBy:------_--------------------------------------------------------- --------- /----- -- --------- <br /> (Plot plan, showing size of lot, location of syste in re ation to wells, it ings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY 4. <br /> APPLICATION ACCEPTED BY-------------------_-----------------.----------------- ------- DATE------------7-- ------------------- <br /> REVIEWEDBY--------------------------^--------------- --------------- -------------------------- ------- ----------------------------- DATE.-------------------_-------I----------------_---------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------40V--------------------------------------- <br /> Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------I-------------------------------------------I---------------------- ---------------------------------------------------------------------I------------------------------------------------------------- ------ <br /> -------------------------------------------------------------------------------------------- ------------------------------ ----------------------------------- <br /> --------------- -------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------­-------------------------­­ <br /> ----------------•--------------- --------------------------------------- ---------- - ------------------------------------ ------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:-------- d <br /> --- ------- --- Date- ---- ----- - ------------------------ <br /> - <br /> ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Strout 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E6-9 REVISED B.59 F.P.CD,ZM 6-60 <br />