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FOR OFFICE USE: <br /> ------ --------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. z..�.�—\ <br /> . <br /> 1 0 (Complete in Duplicate). <br /> +--- This Permit Expires i Year from Date Issued <br /> Date Issued <br /> '--••--••,. <br /> 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 Ordinance No. 549. „ <br /> JOB ADDRESS AND JATN-_- � - _ 4__ -- <br /> - ---� --- -- ----- •.............................. <br /> Ole- <br /> Owner's Name........... r1,,_-,,,_-_,,.. f .-.__ Phone.-•-••--- ............._�,�i <br /> Address -- ------Contractors Name... f _._ � . Phone....___.. _ <br /> Installation will serve: Residence �ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _.1.--_ Number of bedrooms --- - Number of baths ..-/. Lot size ------- =_..: ...4 ,..._ _..--._ <br /> i. <br /> Water Supply: Public system-0 unity system ❑ PrivateDepth to Water Table 6t-'9 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [j Clay [3 Adobe�ardpan [I <br /> Previous Application Made: (if yes„date--------------------y No ❑ New Construction: Yes f No ❑ FHA/VA:.Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: v <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> LicTa k: Distance from nearest well-----------------Distance from foundation__-_--------:---_-_.Material_-----.•-..-_-------............................. <br /> o. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity--........--•--....... <br /> I F• I rice 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 /> 11 <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-,---- <br /> ❑ Number of pits----------------------Lining material_---_--_--..---.___----Size:Diameter--------_-.---------__-.Depth---------------_-_--__--- --_----- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining I material------------------------------------- <br /> ❑ Size: Diameter---------------•-----:-------_--------De th-------------=-----_ . Liquid Capacity p -------•---------------------- q •-----------••-------...--•-gals. <br /> Privy: Distance from nearest well----------------------------------------- ------Distance from nearest building--------_-.:.--_--------------.----------- <br /> ❑ Distance to nearest lot line------------------------------ <br /> -------------------------------------------------------------------- <br /> .. <br /> Remodeling d/or repairing (describe): ' <br /> ��{¢� ------- ------- <br /> ---------------- -----------------• - •-. .... <br /> ­--------- i <br /> --------:---•---------------------- ---------- <br /> --..- ------ --------t:�-...-- ._�:.-�(..._._.- --.__-_ _ ,--�►-��� � __.. -�T�O-- -- �G�-��O�j---_may./��� <br /> ------ <br /> her <br /> certify that I have pfe{�ared t application and +hat the w rk Oilbe d e In accordance with San Joaquin County <br /> ordinances, State s, and rules and regulations of the San Joaquin Loc Health District. <br /> 19$i ned .'� <br /> } '�j---------- c ...----- ---- ---- --- --•-----------. -------- Contractor) <br /> By:--------------------------------------------------------------------------------------------------- - -•-- ---------- (rtle) <br /> (Plot plan, showing size of lot, location of system in relation to well uildings, etan be placed on reverse side). . <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ------------------------ ”: <br /> DATE 23 <br /> BY--------------------------------------------- - ---------------------------------------------------=------------------------- DATE---•---••--.......- <br /> BUILDING PERMIT ISSUED..............................----------------------------------------------------------•---•------- DATE------------- <br /> Alterations and/or recommendations---------------------- ` <br /> -•--•-•--•-------------•-•---------------------------------- <br /> -----------------•--••------------------------•-------•------------ ---------------------------------•-__.------------_.-... :.. --------------•-------•-..-------- ---:..-•-------•----------- <br /> --•------------- ---------------•-------- ... <br /> Y .................•--.-----__-.---.------..----. ---------------------------------- <br /> ---------- <br /> FINAL INSPECTION B ..................... ---------- ---- - -- ------ Date-- <br /> , . <br /> f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 705 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracyr California <br />` EB 9 REVISED 8.69 2M1 6-61 ATLAS - ,r„ <br />