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FOR OFFICE USE: �. ;. �� <br /> /= <br /> �� <br /> - - ----------------- APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete-in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Joaquin Local Healfh District for a permit to construct and insfall the work herein descr <br /> Application is hereby made to the San. <br /> y e . <br /> This application is made in compliance_with County Ordinance No. 549. <br /> pp ----------------------------------------------------------------------------- <br /> Owner's <br /> ADDRESS AND LOCATION------1.•f-�--- - -- - - -- -��------------------�-- ----- -- ---- <br /> a <br /> _ Phone <br /> Owner's Name'----•--�------ - -----`-"•"-"---`-�---------------•------------�---------- ---- ------ --- - - ---- - <br /> Address--.------ IYYN'1� ------ --•------------- -----------•---------- <br /> Contractor's Nam --- - ------------- - - --- -- -- - -- ---------------- ------•------------------. Phone..---- ------------ ----•---•----.. <br /> ?s •• <br /> Commercial Trailer Cour} E] Motel ❑ Other ❑ <br /> Installation will serve: Residence C <br /> Apartment House ❑ ❑ <br /> Number of living units:/A... Number of bedrooms 1-Number of baths.`'I- Lot size /-- --- -------- -------- <br /> Water Supply: Public system D C. mmunity system El Private 60 <br /> Private Depth to Water Table - ft I <br /> Character of soil to a depth of 3 feet' Sand ❑ Gravel ❑ Sa dy Loam [I Clay Loam I] Clay E] Adobe Hardpan C].Previous Application Made: (if yes,date_-_...-__-_-..-- eiNew Construction: Yes [-] No [y!FHA/VA: Yes ❑ No E�' <br /> t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi ankh T Distance from nearest well----.-.:.-_--_-Distance from foundation-------------------.Material ------------------------------------ ----------- <br /> No. of compartments------ ------------------Size------------------- -------•-- Liquid depth--------- - ----- ------- Capacity- 1 <br /> Disposal F' I : Distance from nearest well..- -----------Distance from foundatJ'on-/b.--.-----._.Distance to nearest lot lines__---:--_.-_ <br /> -Len Length of each line--_�P--f-----------------Width of french.-�------------------------ \� <br /> Number of lines.----�----------- ---------- -- g �r p � <br /> Depth of filter material_ Total length-.----b_-U-------------------- ------- <br /> Type of filter material-��.���--�--- P '�"- -- ---� -� <br /> Seepage Pit: Distance to nearest well --------------Distanc� foundation-LO- ........D' ante to nearest lot lisle__ <br /> �� Nbof pits--- ---------------Lining material_-.-- . Size: Diameter_-. _ -_ p 1 <br />{ Cesspool: Distance from nearest well ----------------Distance from foundation------------------ -.Lining material--._---------------------------- <br /> Cesspool: <br /> "--�------------- gals, <br /> ❑ - ---- --- ---- -----------Depth----------------------------------- ---------------Liquid Capacity 9 <br /> Size: Diameter- ;i _ - - <br /> . _- .-Distance from nearest building------------------------------------------ <br /> Privy: Distance from nearest well-------------'---- ------------- <br />' ❑ rest lot line -----,-------------------- <br /> and or repairing (describe):Distance o neo <br /> ' ------ ------•--I------------------------------==:------------------------ <br /> Remodelin ------------- <br /> . -----=-------------------• <br /> -----------••-------------- ••------------------------- - - <br /> ------------------------------------------------------- <br /> t ------------------------------ <br /> ------------t <br /> f I hereby certify that I ha prepared this japplido and that the work will be done in accordance with San oaquln oun y <br /> ordinances, State lawsand es regulatioSan oaquin Local Health District, <br /> -- --- (Owner and/or Con#tactor) <br /> (Signed) --- - - - d <br /> ----------------- -------------- ------. --- <br /> ' --------------------- -----------------------(Title)•---------------- ------- ------------ ------ <br /> By:. <br /> (Plot plan, showing size of lot, loca+i n of system in relation to wellst buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> fDATE------/�--� ` 4` -<-------------------- <br /> APPLICATION ACCEPTED BY----- :¢ - /LIe_ ----f._,� �/ DATE------------------------------------------------------- <br /> REVIEWED BY----- --- ------------ --------- ----- <br /> I ------------------------- <br /> -------------------------------------------------- <br /> BUILDING <br /> ------- -------�---"------- --:7-- ----------- <br /> BUILDING PERMIT ISSUED-------- -- -- ------------------------------------------------- - DATE- --- ----- - ------- ------------- --- <br /> -------------------------------- <br /> Alterations <br /> ------------------------------•---Alterations a <br /> � - -------- <br /> dti - '72 <br /> rK --------- ... . = --- ------ ------ <br /> - <br /> . ------. - --- - <br /> - - --- - - - --- <br /> a <br /> l - ----------- -------- <br /> FINAL INSPECTION BY:- { Date - ; <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naselton Ave. 300 West Oak'Streef 124 Sycamore Street 20.5 West 9th Street <br /> Stockton, California Lodi. [ <br /> I alifManteca,California Tracy,California <br /> ornia <br /> E.H.9 2M 1-67 Vanguard Press <br />