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OFFI EJJE: , <br /> S ---------------- Permit <br /> N <br /> ----------� ----------------- <br /> APPLICATION FOR SANITATION PERMITo. ..��%.f.. <br /> --------------- <br /> _________________ __ ___ V <br /> -(Complete in Duplicate) <br /> _� <br /> __________-------------- <br /> _______' This'Permit Expires I Year From Date"Issued` <br /> as+� 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 /> `m <br /> This application is.m ade in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN <br /> pCATION------- <br /> Owners Name________ ` <br /> ------ ---- ----- Phone. �1� '3U <br /> Address-----=---------_----- = �= t 'A__ -------------------------------•-----------------------•-----.--------------------------•- •---•------------.........-------• <br /> Contractor's Name--------------- •- ----`----f -•---� -- -- c�....-. ---------------------------•------------- Phone..-l. = ---------- <br /> Installation will will serve: Residence ❑ Apartment House'❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> E Number of living units: ..- Number of bedroom-___ Number of baths __ Lot size ------- ___ <c�s �_______________________________ <br /> Water Supply: Public system ❑ Community system 0 Private [R-"Depth to Water Table -Y-2. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay.[] Adobe a3!Rardpan ❑ <br /> Previous Application Made: (If yes,date--------- ---------)"No EV New Construction: Yes ❑ No 2� FHA/VA: Yes ❑ No Er <br /> t r k <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:` `_ # <br /> 1 (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 /> i ,.. r <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 french--------------___-_------------.... <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ <br /> Distance Pit: Distance to nearest well___ _, ____--____Distance from foundation__:y_K__________-Distance to nearest lot line____..-... <br /> Number of pits_____1_--------------Lining material..Y_4z4._k,-',--.-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 /> 0 <br /> — .., - ------------------------------------------ ----------------- <br /> Distance to nearest lot'line-------- - --------------------------- -'--------.._------------..._..... <br /> j Remodels g and/or repairing (describes:____- -f~ss���:_-._ _ .....CW►_41x: .-.--- -••--- <br /> ;�,^ I1,�� ,.,_, ...... -- <br /> ------------------•-------`------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 06 <br /> tordinances, State laws and rules and regulations of the San Joaquin Local Health District. <br /> .. <br /> lea ` > 9 s Owner and <br /> (Signed)----------------- <br /> ------------------- .- ..._.. ( or.Contractor <br /> � � <br /> By:--------------------- IT-- - ...(Title)-------()-L,—A .. ------------------------------- <br /> (Plot <br /> ------ ----- --- <br /> (Plot plan, showing size f ot, location of system in .relation to well , ings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- =-F ------- ------ ------------------------ ---------- DATE........ � lc J---------------------- <br /> REVIEWEDBY-------------------------------------------------- ---------------------------------- ------------------------------------ DATE------------------------- ------------------------------- <br /> BUILDINGPERMIT ISSUED--_---------------- ------- -------------------------- ----=----------------------- DATE-------------___-----------------------------s--------------- <br /> ' Alterations and/or recommendations:-------- ----------------•----•---------------------------•--------------------------- <br /> �� _ ----------------------------------------------------------------......._... <br /> ---- ------ - - __-- - -- -- - --`-- - <br /> !7 --------------------- ------------------------------------- -----------------------------------------I------------------- <br /> . <br /> - <br /> -------------------------------------------------------------------------- <br /> ----- - ------ ------­-------------- Date---------------INSPECTION BY:__ �_ ' <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-9 REVISED a-59 F.P.DD.ZM 6-60 f - <br /> r <br />