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FOR OFFICE USE.. <br /> -------------------=----------------------- ------------- ,i <br /> _______________._..----._-__.------------------.-------- APPLICATION' FOR SANITATION PERMIT Permit No. _/_70.-74 ' <br /> ------------------ r -------- {Complete in Duplicate} <br /> JA j - 1-1 1 Date Issued <br /> - v 5 .}-�- -•- ---- - This Permit Expires i Year From Date Issued I <br /> I 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 <br /> Ordinance No. 549. <br /> JOB ADDRESS ANQ LOCATION- - ---_- <br /> 6 <br /> . �.�� r <br /> Owners Name <br /> 6- &.- <br /> r - e. -- ---- .. .:� d1 ------- ------•---------------------------------•----------=-------------------- Phone-----------..._...-..---•---- -- <br /> Address----------'� <br /> Contractor's Name------------------------- <br /> _----------------- <br /> Installation will serve: Residence A artment House ❑ Co mercial ❑ Trailer Court ❑ Mo//tel//��❑ Other ❑ <br /> Number of living units: _-I-_" Number of bedrooms -_____- Number of baths _-_-�_ Lot size ----------l._-�y _ _ <br /> r <br /> Water Supply: Public system ❑ € Community system p Private Depth to'Water Table J '_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan C]k <br /> Previous Application Made: (If yes,date____________________) Notv New Constructign: Y s g No ❑ FHA/VA: Yes ❑ No EX <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �L <br /> .._..- - <br /> - (Noseptictan-ir_.cesspool- <br /> erm+ed if.puElicser�er,i.s_.av—ai la--ble-within 200 feteet.)Ayw ..1,.. .. " � <br /> Septic T k_�­r' Distance from nearest well-----------------Distance from foundation--------------------Material <br /> ______.._-_.__._______...-__-______._..._._.___ <br />` No. of compartments---------------- -------Size--:- . --------._..._-._----Liquid depth--------------__-_-- <br /> - Capacity---------------------- <br /> f 72 ,1 f <br /> pispvsaI Field: Distance from nearest well__'_.` �-_-..DiAnce rom foundation..--V .___.Distance to nearest lot line----/(----__--- <br /> Number of lines------IX <br /> - Length of each line__:£a___. f ------- Width of trench.____� - <br /> �rvt' Type of filter material_;r-f-_ r� __Depth of-filter material_----/--9_.__._.-Total length-----9.0-1------------------ <br /> eepage.Pit:,. Distanc6 to nearest.well---- -----_ M <br /> ______Distance from foundation____________________Distance to nearest lot line._-________...-._ � <br /> -Number -_-_--- =Lining materials_ __ ____.....Size: Diameter------------------------Depth-----------------.-----.-----Dr <br /> ------------- <br /> Ce pool: Distance from nearest well-----------------Distance from foundation...._._. t <br /> t P -.:---.Lining material-------------------------- --------- <br /> ❑ Size: <br /> Diameter- -------- ------------ <br /> - <br /> Depth _ -- ----------------------Liquid <br /> t ---------- ------------__ga s. <br /> Privy: _ D stance.from nearest.well_____ -------------- nearest building.......................................... <br /> �r <br /> ❑ Distance to nearest lot line---------------- -- _ <br /> f ---------------•--------------------------------i--------------------------------------- <br /> Remodelingand/or repairing (describe):---------------------------------- ------------------------------------• ------------------------------------------------------------------------------- I <br /> -----------------••------------------------------•--------------=-------------------------------------=-------•----------------------------------------------------------------------------------------------r---------------- <br /> -------------------------------------------------- ---------------------•------------------•------------------------------- ----•-------------------------------------------•---------------------------------- -- <br /> ------------------------------- ------------------------•-------•--------------------------•--------------------------------------------------------- -------------•----------------------------------------------- <br /> I hereby certify that I have prepared this application and thatthe work will be done in accordance with San Joaquin County <br /> ordinances, Sta+e laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed} r= ... ------------------------ -y---------------------------------------------------- ----- <br /> ------°------------------- .(Owner and/or Contractor) <br /> - wn or <br /> $Y� = T `- .,.-....� - <br /> - - -- - ------ --------- - - - ------ <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 /> APPLICATION ACCEPTED BY- ---------- -------------- ---------------------------------• -------------- ••••• DATE <br /> REVIEWEDBY--------------------------------------------------------- == DATE <br /> ------- ------ <br /> BUILDING PERMIT ISSUED------------------------------------------------------ DATE <br /> ----------------------- <br /> Alterations and/or recommendations:--------------------------- -------------------------------------------------__-- I <br /> ---------- ---------------------------------------- <br /> --------------------- -------------------- ---------- --------- <br /> FINAL INSPECTION BY:------ =' _` � �-.__ Date. r l <br /> y <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 9M 3-'63 F.P.CD. r <br />