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permit No. .._-- - -•� <br /> ------- ---- <br /> APPLICATION FOR SANITATION PERMIT <br /> -------------- <br /> (complete in Duplicated Date Issued <br /> ------ <br /> ---- <br /> -------------_- This Permit Expires 1 Year From Date Issue <br /> areby made to the San Joaquin Local Health District for a permit to construct and incl the work herein described. <br /> .1 is made in compliance with County Ordinance No. 549. <br /> --------)' <br /> tE55 AND LO TION f Phone------------------------------------ <br /> -----------_------- <br /> Name_. _ a' ----------•----------•-------- <br /> ;SS.................... d f'_.7t�'---------•---------------------------------------- <br /> •--------•-------•--•--•---------- one"--•-_---------------------•----- <br /> / rs_ --1 ------ Ph <br /> ,tractor's Name.-----•----•-•----•--•--.`�-G�--�--�..�•------•--�---••--- •---r�-�� �-- -- `{�------ <br /> Motel Other ❑ <br /> Commercial ❑ Trail Court ❑ � ❑ <br /> .Istallafion will serve: Residence Apartment House ❑ <br /> Lot size -- --��------- ------- <br /> Community <br /> •• .. �•- .............. <br /> .. <br /> Number of baths,/------ " <br /> Number of living units:.--- Number of bedrooms -Private Depth To Water Table ft. <br /> Water Supply: Public system ❑ Community system ❑ Clayay ❑ Adobe❑ Hardpan C]Character of soil to a depth of 3 feet: Sand;( Gravel ❑ San5�New Constructioln- Yesm No ❑ FHA/VA-. Yes E] No 9 <br /> Previous Application Made: (if yes,date--------------------1 No 1;1 � f <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.... =_C�.._--Distance from foundatiLqu`d.cl.-}h--Ma#erial---- Capacity_...- -"!.? ' <br /> r tri <br /> No. of compartments.------.h F -------Size---3 -- T 9 P. <br /> V11 <br /> Disposal Field: Distance from nearest well.--_J_.........Distance from foundation.. ----- -Widthcofttree hest�O--I------------- <br /> Number of lines_- "_ ------Length of each line"".:___-67- ---------_- <br /> �j #h of filter matenal_----,l.F --------Total length------.-1 -.--------------- <br /> -- <br /> of filter material...I_C"c04-=.A-----DeP <br /> Seepage Pit: Distance to nearest <br /> ❑ well Distance from foundation - -.Distance to nearest lot line----------_----- <br /> Number <br /> ---- - <br /> - <br /> -= <br /> Number of pits...__._. -- Lining material ----meter_ Da -- - --- <br /> Distnce from nearest well-_____________ _Distance from foundation-------------------- ningaerial------------------------------------- <br /> Cesspool: <br /> ____Cesspool: -------------Depth.------- --------------•------ ------------------- Lauid Capacity ----"----------gals <br /> • <br /> Size: Diameter <br /> -----,"""-- --- --Distance from nearest building------------------------------------------ <br /> Privy: Distance from nearest well----------------- <br /> --------- <br /> �1 <br /> ❑ Distance to nearest lot line------------------------------------------ --•--"-- <br /> --------------- <br /> Remodeling and/or repairing (describe):------------------------------------------------------- ----------------- 10 <br /> - -----------------•----------------••------ <br /> ------ - -•----- -------- ---•------ _ <br /> ---"•------•------•----•-- ----------------------- ------••-----------------------"-------•-- 4- <br /> --a - ui <br /> Ihereby certify�#ha+ I have prepared application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State Iw and rules and re ula ons of the�San Joaquin Local Health District. <br /> Si ned - ---•--------- •- ----- ------------- - --=-------------- --- <br /> Owner and/or Contractor( <br /> 9 r <br /> v <br /> • (Title) <br /> ------------- <br /> By .--------_------. ----- _- - -------- 9 p <br /> (Plot plan, showing size of to}, location of system in elation to wells, buildings, etc., can be laced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> t�CS---•----------•------------------- DATE.. -- -------------------- <br /> APPLICATION ACCEPTED BY-------------------------- ---- - ---' <br /> -_-" DATE.--------- ---------­-- --------•-------------------- <br /> REVIEWED BY--------•---------------- - <br /> - --------------------------------------------- <br /> BUILDING PERMIT ISSUED-----------------------•---- --•--`------------------ ------------------------------------------------------------------- <br /> Alterations <br /> ------.-- - <br /> Alterations and/or recommendations-------- - ------ --- ----- <br /> - --_.. rte- <br /> ------------------------------------------------------- . . ......(7 ----------------- -------------------------------------- ------------------------------------------------ ------------- <br /> ..............................................................r-------------------- --------------------------- ---------- ........ <br /> ............. ..... ........ ........ ----------------------- ----------------------------------------I-------------------- -------- -------- <br /> ----------------------------- <br /> FINAL INSPECTION BY------- --------- --------•---------- -----•-------------•- <br /> --- Date------------------------------ -------••--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 Wed Oak Srnef 124 Sycamore Street 205 west 91h Street <br /> 130 South American Street Tracy,California <br /> Stockton,California Lodi,California Manteca,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br /> L <br />