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FOR Off ICE/USE: - <br /> � ,�f-( <br /> �p 6 ----- <br /> a---3-- <br /> ______________________ APPLICATION FOR SANITATION PERMIT Permit No. _...l...Y.rl� p <br /> ------ <br />-------------------------- --- ----- -- <br /> - (Complete in Duplicate) <br /> Date Issued ............ ...40. <br />--------------------------------------------------------- This Permit Expires f Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for is 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 LOCATION--1..rP-;?�-f-..5�,�__� "'�' <br /> Owner's Name--------9/1------�Lr'--1.---�+ -------------------------------------------- -------------------------------------------- Phone---------....................... <br /> Address-------------'s� ------------------•------------------------------- - ------------------------------------------------••-•-------_-----------_---_---------------- <br /> Contractor's Name--- -------3-------I---------------------------------- -----------------------_---_................. Phone..............---_--_---.._ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I-__- Number of bedrooms ..-2--- Number of baths I------ Lot size ..7JA!---------------------------------- <br /> Water Supply: Public system Pr Community system ❑ Private ❑ Depth ro Water Tablej---'Q ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoamClay ElAdobe Hardpan C]Previous Application Made: (If yes,date_-------.-_--_.--) No B- New Construction: Yes �No ❑ FHANA: Yes ❑ Na Ct—__ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic TaDistance from nearest well------- ------Distance from foundation--------------------Material---------•----•-------•-----•-•----------------- <br /> No. of compartments--------------------------Size---._....-----------------------Liquid depth--------------------------Capacity.................I..... <br /> Disposal Field: 1 Distance from nearest well-----------------Distance from foundation-----------.�-------Distance to nearest lot I'. -I--------------- <br /> Number of lines..............)------ --- Length of each line-_-__-_�-- _1i---.-_.Width of trench---._Z7`..--_-..-__-___..... <br /> 1•t:p� Type of filter material._-----------------Depth of filter material-_----I_ ---_-. Total length......�_5-----_.- <br /> Seepage Pit: Distance to nearest well.__-----Distancefoundation---1?_.I......Distance to nearest lot line-- <br /> Number of pits.------/------------ <br /> Lining material-------- _C_�_ _--Size: Diameter----Z?,3- _..----Depth----.-.--_ 1-------------- <br /> Cesspool: 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 /> pDistance to nearest lot line----------------------------------------------------------------------------------------------------------------•-------------------------- <br /> Remodelingand/or repairing (describe):--- ---------------------------------------------•--•----------•----------------------------------------------------------------- ---------------------- <br /> ------•---------------------------- --•.------•----------------- •--•--------------------------------------------------------------------------------••------------------------------•-------------------------------------- <br /> hereby certify that I have prepared this application and tha+ +he work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rulesWregulal'' ns oft a San Joaquin Local Health District. <br /> (Signed).-•--------------------------------------- ----- -•-------------- --------------------------------------------------•-••--------------(Owner and/or Contractor) <br /> By:-------------------------------------- -------------------- -- -------------------------------------(Title)---------------------------------------- - - - .........------ <br /> (Plot plan, showing size of lot, lom in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------------- 1 ------------------------ DATE....--- = - ..---------•-------- <br /> REVIEWEDBY------------------------------ --- ---------------------------------- ..------------ DATE-------•----•---.----------------------------- <br /> BUILDING PERMIT ISSUED----- ------------ ------- -. ^ �- DAT ---------------_-_--- - `n <br /> Alterations and/or recommendations:._-.---.l - - _- _-/1-----__---_- - -D-K••-. �..�•-'i•�-��- <br /> -------------------•--•----•-- ••--•---------------•-•--------------------------------------------------- - ------------------.---------•-----------------------••--•----------•----•------------------------------•--- <br /> ------------------- ----------------------••------------- -------...-..----------------------------------•---••---- <br /> FINAL INSPECTION BY:.....�- --- ----•---- ---------- Date--------rJI-------f v- J----&- �------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strut 300 West Oak Srreet 124 Sycamore Strut 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br />