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FOR QFFICE USE: <br /> JLC► J!`- ----------------- <br /> ___�--- - • <br /> APPLICATION FOR SANITATION PERMITPermit No. <br /> -------A-. <br /> ---- -0 _ (Complete in Duplicate) Date Issued __` <br /> - _�----------- -- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Locajr Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ording,4e No. 5 9. <br /> 7 ------- ------------ -•--- •- ---------------- <br /> JOB ADDRESS A LOCA IONS / . I - --- -------- ----------- - ------ q j <br /> -----•- ------ ------- Phone -79-1-/ <br /> Owners Name---- _�__. - <br /> ------- /-- _ ` <br /> - ��x.--�-_cam~_ -- -- - -- ---------------------------------------------•---------------•-------•�rP' <br /> -- -- - ------------- <br /> AddressContractor's Name----------•------•- ---------------- -- ------------------------------------------- <br /> -------------- Phone- ----•----����_�-- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> r / 01 <br /> Number of living units: _/___ Number of bedrooms A-- Number of baths /_- Lot size _ ---- ---1-• Q----•--------------- - <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table-G,9- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobe)g Hardpan ❑ <br /> __ <br /> Previous Application Made:��'{If yes,date____'-_-__"a""�_`1 No❑ New Constraictlon: Yes ❑ . No X FHA/VA: Yes ❑ No ❑. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) <br /> Septic T k: Distance from nearest well--Distance`from fou ndation_-.l-Q________.Material_ /LP---------------- <br /> Se _- -___ <br /> No. of compartments----�----------------- Liquid depth--74 <br /> `-------------------Capacity.. --d----- --- <br /> I Dis osal ield: Distance from nearest well? -Distance from foundation_/�-.------Distance to nearest lot line 5__t___-_._.- <br /> p ,'s�ti.G ar - s <br /> Y� r <br /> Number of lines-----/.---_-- _ Lengfih of each 1 Fne__ L!________�,,___.Width of trench____-. -- ------;-----" <br /> . t r., aterial_��----f----Total length <br /> , <br /> See age if: Dis ante to nearest well_ - -,__-Distance om;f undatio n__ 4----•--- Distance to nearest lot line-�-5_____--_ CC <br /> T e of filter matenaL___�_- - Depth of iter .m <br /> I. ---Lining materE __ _ ---i----Size:jDiameter -----Depth---- ---- S <br /> Nutrlber of pits--._ ._________ <br /> i t a I J_ <br /> Cesspool 1 Distance from near`e'st wellDistance from foundation___________________Lining material__-___--__._______-____--___-_______ <br /> ❑ Size: Diiameter-------------------------------------Depth-----•-------------= ---------------Liquid Capacity ---------------gals, <br /> iF <br /> Privy: Distance from nearest well_______________ .-----------------------Distance from nearest building----------------------------------------- �p <br /> ❑ Distance to nearest lot line----------- -- ---------------------------------- ------ - ------------- <br /> ------------ <br /> ------------ 1 <br /> ------------------------------- --- <br /> ------------- •----• t <br /> Remodeling and/tor repaiHng'(des&ibe):' : - <br /> i <br /> ________________________ __________________ ___.•..___________._________-_---_-______ _____-_-____________._____ <br /> --------------------------------____----------------------------------------------- <br /> I hereby certify that II have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, pi� ws, acid rues and regulations of the San Joaquin Local Health District. <br /> ) ,;,� r (Owner and/or Contractor) <br /> [Signed}-------- --------- ----'- ----------- ---- -�-- - --- - <br /> # (Title - -F----- ------ <br /> - ------- -- -- ---- --- -- --------- ----------- <br /> y------------ --------------------------- ------- <br /> - <br /> (Plot plan, showing size of�lot, location ofOys+em inrelationto`we buildings etc., can be laced on reverse.side). <br /> f =)i i �. r <br /> r FOR DEPARTMENT USE ONLY; <br /> S rV - ------"----� / !fes <br /> APPLICATION ACCEPTI D.BY- Cx � ------------ DATE---------177�---���---�-= ---------- <br /> -----•-- <br /> REVII WED BY • _a I-- - DATE------- ------------------------------------ - -- <br /> r } , - <br /> I PERMIT ISSUED - --b � -- -- ------ -----= ----- DATE - -------------- <br /> BUILDING <br /> Alterations and/or recommendations:�-z-- -- te- r--� -------- <br /> -------------�—; <br /> -ti <br /> ---------- <br /> - .__ -------`'= <br /> [ ------------------------------------------=-----------•------------------- <br /> `--'•----------- ---------" --'------------`:----_------------------- _ ---" ------ -------'--•,'_- --0 '"-"---"-"----' -------'------------------'----------------'----------------------------- --_--_ <br /> t ------------------------------ <br /> FINAL INSPECTION BY:.-- --•------ - ------- Date /---_- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hacale. a��+ 300 West Oak Streetp ! '` 124 Sycamore Street? 205 West 9th Street <br /> toAv <br /> Lodi�Cnliforni <br /> Stockton,California o �`'° Manteca,-California Tracy,California <br /> t <br /> ES 9 REVISED 8-59 3M 3-'63 F.P-CG- <br />