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FOR OFF1 E <br />..... . ................. . ............ APPLICATION F6R' ,SANITATiON PERMIT Permit No. 0 <br />--------- ------ ------ --------- -------- -------------- Date Issued <br /> ---------------- ------ (Complete in Duplicate) ----fl-142, <br /> This Permit Expires 1 Year From Date Issued ­c <br /> -------------- -------- ---------------- o e t <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> ith County Ordin No. 549. <br /> This application is d ccZpIian3;e <br /> ------------- <br /> JOB ADDRESS ANP-t:PC,�PONJ 7- -------- Phone........ <br /> Owner's Name_ ------- ...... ... <br /> •--------------•- -------------............/ , -.1-5 <br /> ---------- <br /> Address---------------- 7___­ - , .........- Phone......•---------------------------- <br /> ------- -­ ---- -------- - ------------------------------------------------------- <br /> ctor's Name.-----_-_------------------ [3 motel 0 Other <br /> Contractor's P___e <br /> Installation will serve: Residence E] Apartment House [D Commercial E] Trailer Court ----------------- <br /> Number of,living units: <br /> ❑ <br /> Water SuPublic Community Number of bedrooms Number of baths --/Lot size ------ -- <br /> ly: -------------- <br /> Private ��Dpth to "Water Table <br /> ppusystem ❑0 ommuny system 11 <br /> Gravel 0 Sandy Loam El Clay Loam 0 Clay 0 Adobe 6_14ardpan 0 <br /> Character of soil to a depth of 3 feet. Sand 0 No H_A/VA: Yes [] No 0 <br /> x:y * g?--` <br /> Previous Application Made: (if yes,date----- ------------ <br /> _1 No New Construction: Yes [3 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> )t <br /> 00 fee . <br /> (No septic tank or cesspool permitted if public sewer is available within 2 -------Material-------------------------------------------------- to <br /> e ja,� Distance from nearest well-----------------Distance from foundation----------- <br /> No. of compartments__________________ Size_.-------------------------,.Liquid depth-------•------------------Capacity--•--•-----.....I..._.. <br /> t ------------Distance to nearest lot line-----------_-­ <br /> % e from nearest well Distance ...... <br /> :�ej <br /> reach <br /> osa Distance s . V .: ---------------------------Length of each line----------------------------�Wiclth of trench----------------------------------- <br /> Number of lines-----_.--- --------_------------------------- <br /> --------Total length----- <br /> Type of filter material______________________/---Depth of filter material-------_------ <br /> m foundationlo...........Distance to nearest lot <br /> Seepage Distance to neares7ll--- -------Distance _33---•------0/ -Dept h---- ---------------- L <br /> ge ��Size: Diameter <br /> Number f pit - --------------Linit . .. ... <br /> 0 ig material.rj_z <br /> nce/from foundation-------------------Lining material_-_____...__-__--------------------- <br /> L Cesspool: Distance from nearest well-----------------Dista Liquid Capacity----------------------------go'$- <br /> 0 Size: Diameter--------------------------------------Depth---------------------------------------------------- ---------- <br /> Privy- Distance from nearest walk_________________________ <br /> ------------------------Distance from nearest building--------- --------------------- <br /> -----------_--------------------------------------------------------------------- <br /> Distance to nearest lot line-------------------------------------------------- <br /> :, <br /> ine-------------------------------------------------- <br /> -------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------------------------------------------------------_---------------------------------- <br /> --------------------------------------------------------------------------------------------------------- <br /> .............................................------------------------------ --------I--------------------- ----------------------I---------- <br /> ------------------------------- <br /> ---------­------------------------------------------ <br /> --------------------------------- --------- ----------------------­------------ ­----------------------------------------------------------------- <br /> --------------------------------------------I---------------­ <br /> -------- --------- -- ------ --- <br /> I hereby c!,r�lfy that I have prepared.-this-applicatio-n anclAaf the work will be done in accordance with San Joaquin County <br /> St e I �*s, and rule and regulations of the San Joaquin Local Health District. <br /> ordina- -.Wl " - %., C__- <br /> 1 4 - ----- F wrier.and/or Contractor) <br /> ---------------­--- ---- <br /> (Signed)....... --------- ------ ---- ---------- - ---I---------- -- -------------- 07A <br /> --- -----------I.,-----­(Tffle)------_. ---------------- -------- ------------- <br /> 1. By:....... P ildings, etc.. can be placed on r�verse side). <br /> (Pic+ plan, showing size system in relation to e , <br /> FOR DEPARTMENT USE ONLY <br /> ------- ---- -- -- ----------------- <br /> ------- - DATE <br /> APPLICATIONCEPTED BY-1/ _ - <br /> 4 ------- <br /> 4 -----------­ DATE-------------------------------- ------------- <br /> Rr:vIEWED BY---...-------------------------------------- ------------------------------------ DATE------------------------------------------- ----------------- <br /> BUILDING PERMIT ISSUED----_---------------- -------------- ---------------------------------- <br /> --------I---------------------------------- <br /> Alterations and/or recommendations: - ------ ---------------------------------------------------------------- <br /> --------------------------------- --------------------------------------------------------------- <br /> -------------------­ 11 -------I------------------------------------------------------------ <br /> --------------------------------------- ----------------------------- ................. <br /> ------------------------------- --------------------------------- I --------------------------_------------------------------ <br /> I -------------------------------------------------------------------------------- <br /> ...................................­------------------- ------------­- -------- i ------------------------------------------ <br /> ---------------------------- <br /> -------------------------------------------------- <br /> --------------------------- ------------------------------------------ --- ---------- <br /> FINAL 'INSPECTION by:;Ijy ... Date------ ------------------------------------------- <br /> --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street'*t <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 9 REVISED 6-59 TM 5-61 ATLAS <br />