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FO,R OFFICE USE. <br /> FAPPLICATION FOR SANITATION PERMIT Permit No. ..... .tt <br /> (Complete in Duplicate) -7 <br /> This Permit Expires 1 Year From Date Issued <br /> Date 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 /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LO N--- r� `' '----------------�----------�---- <br /> Owner's Name------------- �l - <br /> --•-•--- •---- -- ---------I <br /> •----•--•-•--------------- ---- • ---------------- ---------------------------------------------------------•------- <br /> ------ --• - <br /> Contractor's Name----------------------- ----•=i=------------------•----•----------------- ------f'`'�- y Phone.......................---------- <br /> Installation will serve: Residence JR1,I Apartment House ❑ Commercial ❑ Trailer 'Court ❑ Motel ❑ Other ❑ <br /> Number of living units:' ---/--- Number of bedrooms __$/_ Number of baths ._L___ Lot size .......�i___CA�r _,, _, .-11-- --------------- <br /> Water Supply: Public system x Community system ❑ Private ❑, Depth TO Water Table .°Z--�rft. (' <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [ISandy Loam El, Clay Loam tR Clay ❑ Adobe❑ Hardpan Elw <br /> Previous Application Made: (If yes date._/yl" _(.}' No ❑ New on Yes ❑ No [�' FHA/VA: Yes ❑ No Q <br /> TYPE OF INSTALLATIONQAND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . <br /> 1� S <br /> Sep$ie�T/�n '^� istance from�nearestwell_____________� D*tanCe from foundation--------------------Material__._____________._._..._..._..._____________.._.. <br /> �[� I o- of compartments--------------------- -Size------- ------------.r-------.Liquid depth--------------------------Capacity------------•--------- <br /> g1 f Distance from nearest well, k0=_5 Distance from foundation_.__._ _ _.Distance to nearest lot line------ <br /> Number <br /> ____ . ... <br /> Nu ber of lies____________________1_,_..__#�_t"rLen th,of each line_-..___-____ .__---# *-._.Width of trench______._______'Z'r__________ <br /> g <br /> Type,of filte;; aerial_-•4 -- - eDe,th of filter material------�: --------Total length---------------•--•-- --- -------.._sly <br /> Seepage Pit. Distance to nearest•well------/moo__Dis+ance from foundation_.___f 0.9___.Distance to nearest lot line_____��___ <br /> Number of pits �1---------------Lining material__ ---Size: Diameter___-•- _-- _ ___-.Depth--------''L �i.:.__�---____-- <br /> Cesspool: Distance from nearest well---------------- Distance from foundation--------------------Lining material--------------------.......... <br /> ...._-_ ~ <br /> ❑ Size: Diameter•-1-1---"-------------------------- IDepthI---------------'---------- --------------------__Liquid Capacity.__.--------------------gals. <br /> Privy: Distance from nearest well_________________ _________- _,Distance from nearest building----------------------------------------- <br /> ❑ •r ' ws '` -------------------- ----------------•-------- <br /> Distance to nearest lot line_____.___`_____ _____________ _______ <br /> s a <br /> Remodeling and/or repairing (describe): r ---------- ------------------------••-- <br /> _"�-->! �- t t r <br /> -- <br /> - 3-3r �- — <br /> �_• --------------------------------�..'% .. ........... .:_ --------------------------------------------------------------------------------- ----------------------- <br /> I hereby certify at I have prepared'this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State ,sand rules a '� ations of the Sari,Joaquin Local Health District. <br /> (Signed) � -� ' -- ----------- ----- ------T------= -------- ------------------------------------•-•-•- (Owner and/or Contractor) <br /> k� ------------ --------- --------- ---------------------------------•------------------------------=------(Title)---------------------------------------- ------ <br /> (Plot p showing size of1ot, ocation of system in relation to wells, buildings, etc.,-can be placed on reverse side). — <br /> �, FOR RT' ENT USE ONLY <br /> APPLICATION ACCEPTED BY = AA� t ---- x DATE 5� <br /> I REVIEWED BY " '"`.__- ---=--=--=-------------------- DATE <br /> --- ............................................................ <br /> BUILDING PERMIT ISSUED----- ­_­---------------------------------- DATE-------•-------•--------------------------------------------- <br /> MAlterations and/ror recomm nd'ations:-------=------------------------------------------------------••-------------------•-----------------------------_-------------------------------------------__ <br /> ___--•-•----•--------------------•-•----..-...----- <br /> . .. ----k-----------------±--------------- -------- __- ------ . ...�.� ---------------- <br /> --------------------------- <br /> �. <br /> 1� -4. <br /> ---------------------------------------- --- -• -------------- ------------------ <br /> ------------- ---- ------------------- --------------- <br /> I <br /> FINAL INSPECTION BY------------------- f✓S-.__ Date_--------- =-- ----- <br /> SAN JO QUIN 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 /> E5 9 REVISED 8-59 2M 5-62 ATLAS t <br />