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FOR OFFICE U E: <br /> �7 ' ----� -- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------ <br /> 1_.e----F-------------------------------- {Complete in Duplicate} �� 6 <br /> _________.---.------______----.-.------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued"'.--•- - .-_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construcja install the work herein described. <br /> This application is de in compliance with County Ordin ce No. 549. <br /> JOBADDRESS LOCAT ....�'1 --�-7--------------- ..----------------------------------------------------------••-•- <br /> q !- <br /> Owner's Name---- ------- ---- ---- ------------------ ----•---------------------------------------------------------------------------•------------- Phoney. ✓ i` <br /> Address -------- <br /> f <br /> � <br /> - Phne .._Contractor's Name_- '--- --=- ---- -- -- b �, <br /> Installation will serve: Residence 0Apar+ment House ❑ Commmercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:.-. -- Number of bedrooms . Number of baths _/---- Lot size -_ --r.- ..-- f�` -r_-_-..-_ <br /> Water Supply: Public system)4,. Community system ❑ Private ❑ Depth to Water Tables, ft. <br /> Character of soil to a depth of,.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: -{If yes,date--- I No_75 Jew Construction: Yes ❑ No 2 �HA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> F <br /> tic Distance from nearest well-----------------Distance from foundation---------------------Material-------.-----------_-------.-------.-----_-----. <br /> No. of compartments--------------- ----------Size----------------------- ---Liquid depth---------------- ---------Capacity-•----------- ------- <br /> sal i t Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-----------.----. <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------.--------------------- /v <br /> Type of filter material.•-_-:_----------------Depth_ of filter material_----_----------_.---_Total length-------.-------:-------.---------_-------- <br /> f <br /> Seep a Pit: Distance to Weare t well_ _ --Dista ce from oundatior .0-- -._..Distance to nearest lot line-------©--._ <br /> Number of pits--- -----------------Lining mate ial..� - -----Size: Diameter.13��1-------Depth_� �-------.--.-----. <br /> Cesspool: Distance from nearest well-----------------Dista fr 1 oundation---------.----..---.Lining material------------------------------------- <br /> El Size: Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity--------------------- ----gals. <br /> Privy: Distance from nearest well------_-----..:__--------------------------------Distance from nearest building---------------------------------------- <br /> ❑ Disfance to nearest lot line----- --------- -------------------------------------------•-------- ------------------------------------------------••------------------- <br /> Remodeling and/or repairing (describe)------------------ ------------'------ ---------.---- ------------ - ------------------ <br /> -----•---•------ -•-------•------------------------•-••-------- <br /> = ------------ =-----------------•---- --------- ------ --• ---- ---------------------------------------------- <br /> --------------- <br /> -------------- --- --.-- --- <br /> ------------------------------------ ------------------•-p•--p------------------PP-------------------------••----------- ----------------------------------------------------------------------------------- - <br /> I hereb if that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordin laws, and les and re latio of the S aquin -ocal Health District. <br /> Signed} , .--/-�------ 4 r Contractor <br /> v` --------(Title)- <br /> By:--------------------------------------------------------------------------------- - <br /> (Plot plan, showing size of lot, location of system in-relatio�o wells, buildingl, etc., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.... ----------------------- DATE------c -�� ------- -• ------------ <br /> REVIEWEDBY----------------------------------------- -- --------------------------------------------------------------------=---------- DATE---------------------------------------------------•------- <br /> BUILDINGPERMIT ISSUED_.-------------------------------------------------------------------- --------------------- ----- DATE-------------------------------------------------------- <br /> Alterationsand/or recommendations:------------------------------------ ------------------------------------------------•--•-----•--•---•---- ­------------------------. ------_----------- <br /> -•----•--•------------------------- + - <br /> p'�---•- <br /> ------ <br /> -------------------- ----------­------------------------------------- -------- ------------------------- ----------------------------------------- -------------------------------------------------------------------- <br /> FINAL INSPECTION BY:..€f=- -f��-------- Date 1�� T -- - ---------------------------------- <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 /> ES-9 REVISED 9.59 F.P.CD.7M 15.60 <br />