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I-UKUFFICE USE: <br /> ----------- L <br /> ----------- -- ----- <br /> 114-11-1 APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ................ <br />---------------------------- (Complete in Duplicate) <br />---------------------- --------------- This Permit ExpireSrl 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 /> JOB ADDRESS AND LOCATIO <br /> -------ore- - - --- -- ----------------------------------------------------------------------------------------- ------------- <br /> Owner's Name.. <br /> Address-- ........ .. - - --------------------------------------------------------------------- Phone...........__....-------•--•--• <br /> ............ ......e...... ...... <br /> :; ------- <br /> Contractor <br /> ---- *-------------------­­---------------1-11,-------------­-------I------------------------------------------------------- <br /> Contractors Name------------ 4*799/-w------------------------------------------------------------------------------------ Phone.................................. <br /> Installation will serve: Residence [A--Apartment House E] Commercial Trailer CourE [] Motel [I Other ❑ <br /> Number of living units. Z--- Number of bedrooms .2-- Number of baths -,/-- Lot size <br /> Water Supply: Public system Ur"tommunity system 0 Private 0 Depth To Water Table XA9 ft. <br /> Character of soil to a depth of 3 feet: Sand El Gravel F <br /> ] Sandy Loam E] Clay Loam [] Clay [] Adobe�arclpan I-] <br /> Previous Application Made. (If yes,date--------------------1 No ®o—New Construction: Yes 0 No 2�/ HA/VA. Yes E] No 41 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No sopfic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tamk- / Distance from nearest well-------------- Distance.from fouinclaf ion--------------------Material------ <br /> No. of compartments-•----------- -------------Size--------------------------------- ------------------ <br /> Disposal Field:, Distance from nearest well.__--------------------------Distance from foundation....................Distance to nearest lot line..--__-......._.. <br /> jxbsZerif Number of lines------------------ Length 61' each line----------------•------- ----Width of trench..-------. -------- <br /> Type of filter Depth of filter material-----------------------Total length-__-..._----_........_- <br /> -------------------------- <br /> ---1—— 11 <br /> Seepage Pit: Distance to nearest well----- rRgn fou 01 n0..1S--*...... <br /> .-_-_Distance f,o f 0,ation.....46.........Distance to nearest lot Ii -- <br /> Number of pits----.----/--.-----_Lining material----e-VA"- ---Size- Diameter-w?S!�---------Depth--�i:5774.................. <br /> Cesspool: Distance from nearest well-----------------Distance. from foundation- -----------------Lining material...----.---.-__- <br /> -----•-- -------------- <br /> 11 Size: Diameter---------------------------------------Depth-----------------------------------------------------Liquid Capacity-------------------­------gal <br /> Privy: Distance from.nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line-------------------- <br /> Remodeling and/or repairing (describe):_-.--_--'-------------- <br /> 1 -U0,xWZa04.................... -•-•---------•--•••----------•-------- <br /> ................**------------------- <br /> --....................-------------------------------------------------------------------------------------------- -----------------------0-1---------------­----I------------------------------------------ <br /> ------------------------------------------- ------------------------------------------------------- ---------------------------01--------*------------------------ ---------------*-------------------- <br /> ---------- <br /> .--------•------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- <br /> I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and ruys and regulations of the San Joaquin Local Health District. <br /> (Signed)-------------------- ��--------- ------------------------x?------0---------------------------------==------( r Contractor) <br /> BY:........................ -------------------------------------------------- -- ---- <br /> (Plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------A/ <br /> ----------------------I--------------------------------------------- DATE------- <br /> REVIEWED BY ---- ---------------------------------- <br /> BUILDING PERMIT.ISSUED -------------------•----- --------------­------- DATE------------------------ --------------------•­ ----- -----------—---------------------- DATE... <br /> Alterations and/or recommendations:. - -------------------- <br /> --- ------------ --- ----------------- ...0........ <br /> ----------- --------- <br /> ----- --------------------- <br /> -------------- ——---------------------------- <br /> ------ --- - -------------- -------------------- <br /> 4? <br /> --- -------- .. .... ------------------ ...... <br /> ------- ------------------------------------------ ----------------- <br /> -—-------------­ ------- <br /> -- --- 7......... <br /> 3 ---------- <br /> FINAL INSPECTION BY:-- <br /> ------- ------ Date- g ---- - -- <br /> SAN ------- ------- ­----------------­ <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Stisost 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-59 2M 5-62 ATLAS <br />