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FOR OFFICE USE: <br />------------------------------------------------- --- - <br />-------------------------------------------------------- <br /> APPLICATION- FOR SANITATION PERMIT Permit No. <br /> ---------------------- -------------------------- (Complete in Duplicate) <br /> ----------------------- ---------------------------- • This Permit Expires 1 Year From Date -issued 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 /> V1 -2 <br /> JOB ADDRESS AND LOCATION_UlEi:i. 4�-----I- ------------ ---------------------------------------------------------- <br /> 0 1 5`17 17—3 4 � <br /> lI <br /> Owner's Name........fg-,e�_ �._ ----------_13 -- ----­------------------ -------- ­----------------------------- Phone-- --1-- ............. <br /> Address.............. -------- ------------ ------- ............ -f------------_------------------------_--------- <br /> Contractor's Name--------- ....... ------ -----------------------------------------------Phone-.--g .......................... <br /> Installation will serve: Residence JRJ Apartment House El Commercial [] Trailer Court E] Motel 0 Other 0 <br /> Number of living units: J---- Number of bedrooms A_ Number of baths _4--- Lot size ---- ----------------------- <br /> Water Supply. Public system E] Community system [] Private Eff Depth TO Water Table .__- ft. <br /> ' <br /> Character of soil to a depth of 3 feet: Send Gravel [] Sandy Loam [I Clay Loam ❑ Clay 0 Adobe[] Hardpan C] <br /> Previous Application Made: (if yes,date--------------------) Nog New Construction: Yes [] NoW FHA/VA: Yes o No 9 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__n!7��......Distance from foundation-_/ ----------Material-- --0 -------- . ........ .111-4C <br /> Ice <br /> No. of compartments---------;X-----------Size_.X1r47X_,9--------Liquid dep�h---------- =paci�t�y__J......... . <br /> Disposal Field: Distance from nearest well _—f70------Distance from foundation---f;3:4:-------Distance to nearest.lot <br /> Number of lines.............../;------- -- ---Length of each line-----------IC4�-----------Width of trench---mr�4_------------------------- <br /> Type of filter maferial/.i�_Ai4,Depth of filter material------A-V---------Total length.......6'Q_-_______--_"_______________ ' <br /> Seepage <br /> 0­--------------­---------- <br /> Seepage Pit: Distance fo,;nearest well----------------------Distance from foundation--_---------------Distance to nearest lot line-_-_-___________- (Dh, <br /> El Number of p <br /> f its--------------_------Lining material----------- <br /> ------------Size: Diameter__._-_.--.-----.------ Depth--------------------------------- <br /> Cesspool- Distance from nearest well_________________Distance from foundation--- --------------- Lining material._______-_-___"_____._--__-_-________ �, <br /> ❑ <br /> aterial------------------------------------- <br /> El Size: Diameter-------------------------------------Depth---- -----------------------------------------_Liquid Capacity..----------------------__ga S. <br /> Privy- —.Distancefrom­nearest well------------------ -------------------------------Distance from nearest building______________.___----------_________-__-- <br /> ❑ Distance'to nearest lot kine---------------------- -------- -----f-------•---------------•-•-•...-----------------�-------------------.._..------------------- <br /> Remodeling and/or repairing"(describe):--------- -- --- ------- <br /> -------- C <br /> I -,— ---------------------------- <br /> . . -------------------------------- ----------------------------------------------------------------------------------------------------------------------- ----------------------------­- <br /> --------------------------------------------------------------------------------I.,----Z------------------- ......---------------------------------------------------------------------------------------------- <br /> ------------------------------------ ------•------ -------•-•----------------- ---------------------------------------------------1-----------------------------------------------------11---------------------------- <br /> �1> <br /> I 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 and regulations of the San Jo uin Local Health District. <br /> (Signed) <br /> FP- -- --------- -- ------- ------------e—------- - ---------L---------------------------------------- ------------------------(Owner and/or Contractor] <br /> - -- ----- -----------------------------_ ---------------------------------(Title)- --- -------------- <br /> system in re ion to wells, buildings, etc., can be placed on reverse side). <br /> system in re <br /> (Plot plan, showing $size. Or I y, <br /> FOR DEPARTMENT USE ONLY <br /> 7 <br /> APPLICATION ACCEPTED BY--'--- FAR.:�.r-------------------------------------------------------------------- DATE------------- - <br /> REVIEWEDBY-----------------------------------------------------------------•-•--•----------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------—------------------------------------- DATE----------•------------------ ------------------------------ <br /> Alterationsand/or recommendations--------------------------- --------------------------------------------------------------I-------------- ------------------------------------------- <br /> ----------------------------------------------------I----------­------­- -------------------------I -----------------------------------.--------= --------------------------------------------------------------------- <br /> . s '14 -------- ---------------------------------------------------- <br /> -------------------------------------------------------------- ---- ------------ ---------------------------------------­�-------------------------- <br /> --------------------------------- -- ­ -------------- --------------------------------------------------------------------------------- <br /> - ------------------------------ --------------------------------- <br /> ---------------"_._...-•-`------------.---....----. -__- - -------- ........... - -- ----- - - ---------------- ---------------- <br /> Date.... .... .... ------------- <br /> • <br /> _.............. 4�_ ........... <br /> FINAL INSPEC. ---- ---- - --- --- .(7 <br /> $AN JOAQUIN LOCAL-HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street f 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5.62 ATLAS <br />