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FOR OFFICE USE <br /> APPLICATION FOR"SANITATION PERMIT Permit No. . 1 ' .. <br /> - ----- ------------------------------------- (Complete in Duplicate) <br /> " � 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 construct and install the work herein described. <br /> This application is made in compliance wit County Ordinance No. 549. O <br /> •'jf2.�( � moi• � ' <br /> -------------------- <br /> JOB ADDRESS AND LOCATION: -- ------ ------&'------ <br /> Owner's N me timrr ------•----- j ------•- -- -- ------ - ._. <br /> on <br /> Address- >� � �J`�•- - -------------- -------•---------------•-- <br /> Contraeto ' Name--------- - ----r---• . •----- �7 e�/�- +--•---- ------ ---•------•- hone? + ►3 .0 v'� <br /> Installation will serve: Residence Ap artment Ho sU e ❑ Commercia E] Trailer Court ElMotel ❑ Other [:1 <br /> Number of living units: -1-___ Number of bedrooms --J-. Number of baths .,2___ Lot size --•--•--•----•- <br /> Water Supply: Public system ❑ Community system ❑ Private Ar Depth To Water Table*___ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam or Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Mede: (if yes,date___________________) Nox New Construction: Yes It No ❑ FHA/VA: Yes ❑ No,�r <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__ Distance from foundation__ __ r Mater'al._____ ......................... 1 <br /> �+ No. of compartments_____.--------------Size- - s ---Liquid depth - <br /> --------------Capacitye!V,�ra X 1+11 <br /> Disposal Field: Distance from nearest well-wV__Q_.-."Distance from foundation__ -•.Q Distance to nearest lot line---sS.1....... <br /> Number of €ines______ _________ ------- <br /> - <br /> "� _ ____.____Length of each line_.__ ""-�"_______.Width of trench.......o�_�_..'.....____. <br /> ' Type of filter material._. &#e-----__Depth of filter material___./?��__._Total length__._. ...................... <br /> Seepage Pit: Distance to nearest well_lae_______Distance fr m f undation__�Q..�.._..Distance tg,nearest lot line__�5�'_.___.. <br /> (�r Number of pits__-_„Z____________Lining material__ _.__.Size: Diamete r_ �Y8__'.Depth____s __/.' �...- " <br /> { <br /> Cesspool: Distance from nearest well-----_-----------Distance from foundation___-----------.-----Lining material-___._.___________-._____.__________- _ 1 <br /> ❑ Size: Diameter--------------------------------------Depth------ --------------------------------------------.Liquid Capacity..-----•--•---------------gals. <br /> Privy: Distance from nearest well.__.------------------------------------- _______Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line- ---------------------•------------ ----------------------------- .......------------------------------•---------------------------- <br /> Remodelingand/or repairing (describe)---------------------------------------------------------------------------------------------•--------------=--_--_----------------------------­-- <br /> -------------------------I——-----------------------------------------I---------------------- <br /> --------••----------------• -----•-------•----•--------------•------•--------------------------------....---------------•---------------•----------------------------------------------•----------------------------------------------.------ ----------- <br /> ---•--•----------••------_"----------------------------•-----------------•----------- ••-•--------------••-•---•------------1---- ---------------------••-----------------------------•---••-------•------------------ l <br /> -----------------------------•-- ---------------------••---------------------------------------------------------------------------------------------------------------------------------•----------•-- --------- <br /> 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 Joaquin Local Health District. <br /> (Signed) ----------------------------------------------------- ----------------------------------------------•--•------- ---------- ----._.(Owner and/or Contractor) <br /> r} By: �.:.:_.. -^� --- ------- --- (rile] :.._... <br /> Plot Ian, showing size of ot, Iocetion of s/ ystem in relation to ells, buildings, etc., can be placed on reverse side). <br /> ( P <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-._-- --- - --- --- ---- DATE_._. 1- -=6_------------------ -- <br /> REVIEWED BY------------------------------------- ------- -------------------F <br /> --------------------------------- - - -----•-------------------.. DATE--------------..-------------------------------------------- <br /> BUILDING PERMIT ISSUED............. -•-------------------------------------- ---- DATE----------...........--- ----.-- - ------ <br /> Alterations and/or recommendations:---------------- -- 1 •------c -''_ <br /> ...............................................................------4:��:-•.--------------. 1. ----•---------------------------------------------...--••................................... -------------------------- <br /> ---------------------- <br /> -----••--------------------------------------- --------------------------.------------------------------ ---------- ----------------------------------------•-------------------••--•-•- .-.-----•-------------------•------•-•------------•-- <br /> FINAL INSPECTION BY:--- 4�_ - --. Date <br /> --------------------------------•-------••- <br /> SAN JOAQUIN 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 ZM 5-62 ATLAS , <br />