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rvR jrri%-cuoc �i <br /> ------------------ APPLICATIONFf)R SANITATION PERMIT Permit No. .. <br /> --------------- - --------------------------------------- (Complete in Duplicate) t� <br /> -------------------------------------- This Permit Ex fres 1. Year From Date Issued Date Issued <br /> - 1j <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 ATI <br /> �3_v .. --- ----- <br /> Owner's Name_. .. '. .... ---------•------------------------ ------------- ------------------ ----------------- Phone.................................... <br /> Address__. <br /> Contractor's Name............... <br /> ---...---•- -------------------•-•------ Phone................................... <br /> Installation will serve: Residence ❑ °Apartment House ❑ Commercial Trailer Court E] Metal ❑ Other El <br /> Number of living units: .'-_"-'.. Number of bedrooms _^__- Number of baths .. _- Lot size ,J�_.__X. ig .._........................... <br /> Water Supply: Public system ❑ Community system ❑ Private RI'l6epth to Water Table _ Qft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 25"A"ardpan ❑ <br /> Previous Application Made: (If yes,date--------_----------:_j No [L?'*New Construction: Yes ❑ No 2-`FHA/VA: Yes ❑ No <br /> gj­ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic lank:? Distance from nearest'well.................Distance from foundation--------------------Material-_____........................................... <br /> ,t A2 No. of compartments------------------ :Si e-------•---•--------------- ---Liquid depth---------- ---------------Capacity,....................... <br /> Disposal Field: Distance.from nearest well_ _Ti�_� Distance from foundation---/___.....Distance to nearest lot linelv....-_. <br /> Number of line's _- `. - '` ____ __ ength of each line---1B.P.�----------• Width of trench___A.........--------.--- <br /> Type of filter mst�riel.���/ e th of filter material___ Total length____la --- ............... <br /> 4 p _,, fir/ <br /> See age Pitr Distance to nearest well__ sit .._____D.istance fr m fo dation__��.7 ___..Distance to nearest lot iine__-a�........... <br /> Number of p'its___1 Lining materia _Size: Diameter_. .............Depth---.«-------------------- <br /> CeSZ4 - <br /> Distance from nearest well.................Distance from foundation--.__-_____________.Lining material-------_---- <br /> Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity.---------------------------gals. <br /> Privy: Distance from nearest well--____-_______-_-------_---------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line______`:_:"____ <br /> --------------------------------------------••------------•------------------••------------------- <br /> Remodeling and/or repairing (describe)--------------- <br /> = <br /> ........................•-----------------------------------------------------------------•----------------------------------------- ------.----------.----------------------.----.---------.._..----_---- <br /> '"-----------------------------• _l---•---------•----------------------•--•---------------•-------------•--------••----------------•-------•--------- <br /> --------- ----•---------------------------- -----------._...---------------------------------•----------•----•-----------------------------.._-----------------------••---------------------------------------------------- <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, an rules aand.,,regulations of the San Joaquin Local Health District. <br /> (Signed)------------- v__ <br /> ---------- =---- ------•----------- .... or Contractor) <br /> W <br /> By:---------------........................----- (Title)----�✓.. -- <br /> (Piot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED. BY------ - -------------------------- ------------------------------ DATE-------`+ S- =-L--------------------------- <br /> -------._--.---- - -•- <br /> REVIEWEDBY---------------------------------- ----------------------------------------------------------- -----_----------•---•----._._ DATE------------------------------ <br /> ----------------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE <br /> Alterations and/or recommendations: � _ i- _.t` t.t_ts•. st ��€.' -......... . <br /> t <br /> k-- .-.----•---------•--- --------•----------------•--•-----............-------•-------------.------.._... --------- ........... <br /> FINAL INSPECTION BY:... ..........ts -{------------------------------- Date._..' '•t` `= <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 3_ <br /> 130 South Amerlian Street 300 Weef Oak Street '134 Sycamore Street k. 105 West 9th Street <br /> ~Stockton;Califo,n[,-•-j- Lodi,California . i Manteca,California Tracy,California <br /> ES 9 REVISED 6.59 eM 6-61 ATLAB <br />