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APPLICATION FOR SANITATION Pt'R4T-;;� Permit No. ... ...... <br /> (Complete i <br /> n Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constru �inst the work her)described. ._ <br /> This application is made in compliance with County Ordina e No. 549. <br /> JOB ADDRESS AND LOCATION----------3�'v_3--- -------------------•------------------ ----------•-------------------------••-------------------•------------ <br /> Owner's Name--------- ---------------------I--------•-•------------ -- ----------- Phone_.---------------------------------- <br /> Address--------------------------------------------I--------------------------------------------------------------------------------------------------------------------•------------•-------•--------------•-----.----- <br /> Contractor's Name---------------------------------------------------------------------------------------------------------------------------------------------- Phone----------•------------------------ <br /> 4 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of I units: Number of bedrooms -------- Number of baths -------- Lot size ____________________________________________________________ <br /> Water Supply: Public system D�_' Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeZ Hardpan ❑ <br /> 3 <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND,SPECIFICATIONS: <br /> {No septic:tank or cesspool permitted if public sewer is available within 200 feet.) <br /> % -- 5' �� <br /> Se ti ank: "Distance from nearest:weil ______________Distance from foundation______ __________._Mater, 1_ _____-._-___ <br /> No. of compartments____.. ✓____- ._..__Size_-_�----x__ _� L'iq'uid depth_____ ___� ._ __ P Y ---------- <br /> ���!ll���"` qq""`� Ca acit <br /> Dis os I Field: Distance'from- nearest:w.61 1-1-._�d---Distance from foundation-_._l .......Distance to nearest lot line-------- <br /> Number of line s_____________ ___ ______ __ Length of each line=__ - T f <br /> �--=----------W�dth of trench.------�'-�--------------•- - <br /> E ,_.. .... 6?". <br /> ,rType of filter 'aterial-- ._Depth of filter mate+ial________. .,k._.___Total length_________________ .-- ___._.___. _ <br /> Seepage Pit: Distance to nearest well___________________Distance from'foundation_I:'_____---______.Distance to nearest lot line----------------- <br /> '4 ❑ a "= Number of pits----------I---------- <br /> `Lining material---------------------?-Size:y Diyameter-----------------------Depth-.-.---------_------------- _-• <br /> Cesspool: Distance from nearest well__-------------Distance from foundation--------------------Lining material------------------------------------- <br /> d, Size: Diameter- --------- ----------} ----------Depth-------------------------------------------- -------Liquid Capacity--------------------------..gals, <br /> Privy: Distance from;'hearest.well _-w---------------------------------------------Distance from nearest building_______________________________ ________ <br /> ❑ <br /> Distance to ne.:a{resf lot line --- ----------------------------------------------------------•--•-•------------------------------ -------- ---- <br /> f <br /> Remodelin and/or repairng (de3cribe);� _ ----------------- ---------------- ------• --------•---- ----------•----------------- --- --------------- <br /> T" <br /> -------------- <br /> --- ` {-�,t'-`-"�- --- �' ------ <br /> .....f 4- a --------------- � "��---d-=---'`----- <br /> = ---------------- <br /> --------- I <br /> ---------- - - L = <br /> -------------------------------------------------------- ----------------------------------------------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules �n, regulations of the San Joaquin Local Health District. <br /> (Signed)------------------------------------------ <br /> --�---------------------------------- ------------ ---------------------------------------------------------------------(Owner and/or Contractor) <br /> By:----------------------------------------1___]-------------------------------------------- -----------------------------------------{Title)--------------------- <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 /> ------------------------- <br /> REVIEWED <br /> -- ' <br /> REVIEWED BY-------------------------------- <br /> ----- ---------------------- - ° ------ -- _-- ---- DATE---- ----- <br /> BUILDING PERMIT ISSUED--•- �----�.. — -- .,.». SATE <br /> ..w�. _M ,........,�, <br /> Alterations and/or recommendations: •."`-- '.�-�--------------•------••-----•--•--------------------------------•------------------- <br /> -------------------------------------- <br /> f� -----�------- V =�'` ---------------------------------- <br /> --------------- <br /> ----- ------------------------------------•-- ----------------- ------------------ ---------------------------------------------------•------------•-----------•-----------------------•------------ -------- ------------------- <br /> i <br /> -----------------------------•-----•-----------------------•------------------•------------------------------- --------------­­----------------------• •---------------------------------------------- --------------------- <br /> FINALINSPECTION BY-------------_-- --------------------------------- ----------- Date----------------------------- ------------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California „Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Rev'Sed 8-'59 r.P,CO- <br />