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`-.`_'"'FOR OFFICE USE: <br />- ------- <br /> ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. _l.f .L... <br />------------------------------------------ -----=--- (Complete in Duplicate) Date issued ` •�� <br />--------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei d cFibed, i <br /> This;,, plicationris-m de=in compliance with County Ordinance No. 549, t <br /> JOB ADDRESS DSL CATION- / F <br /> Owner's Name_ hr�._ '�' rt-.c.l '.. . �r' r .--------_----------- ----------------------------- Phone----------------------- <br /> ` <br /> Address------ , <br /> .. _l_.J.i3_...__ _ <br /> Contractors Name-----_ -_moo --t -f ---- -7-/0-7------ Phone------------------------ � <br /> Installation will serve: Residence WApartment House El' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: j-___ Number of bedrooms .2-__ Number of baths ---I... Lot size .......... . .. .. <br /> -------------------------•- <br /> Water Supply: Public system ❑ Community system ❑ Private Ell Depth To Water Table _ ..... it. ' <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________} No ❑ New Construction: Yes ❑ No [❑ FHA/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 /> Septic Tank: Distance from nearest well_________________Distance from foundation....................Material____._________--_.__.._..._.....-._____-___----_. <br /> El No. of compartments--------------------------Size-------------- Liquid de th__________________________Capacity • <br /> Dispos ield: Distance from nearest well.:;5��--------Distance from foundation----Al___!......Distance to nearest lot line-__- '_ _... <br /> Number of lines..........I---------------- Length of each line----- ___'____--_-._.Width of trench.-.-Z.' _________________.._ <br /> Type of filter material._._ ---_---_Depth of filter material______-12.......Total length_____-1A-_--_____________________ <br /> Seeps Pit: Distance to nearest well---�_pO___-___-_Distance from f undation_...� _....._..Distance to nearest lot line__.•_SS.�._... <br /> Number of pits._________________Lining material__ �__.Size: Diameter-------c�o-:r.___.Depth---e�s�...____ .._ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material......................... <br /> :_..._._____ <br /> [) Size. Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------- <br /> Privy: Distance from nearest well _____________--------------------------- -------Distance from nearest building----_---__._.--.._--__________.___._____-- <br /> ❑ Distance to nearest lot line-------------------------__--------------------------------------------------------------------------------- --•--------------------- <br /> Remodeling and/or repairing (describe):--------------------------------------------------•------------------------•--- •----------------------•-----------•----------------------------------- <br /> ....--------•-------------------------------•---•--•-•-----•-•---------------------------I--------------------•---------------------------------•---------••----------------------•--------....._----------------------------- 1 <br /> ---------------•-••-----------------------•---------- ....--------------------•-----••------------------------._....-------------------------------------.---------------------------------------------------------------- <br /> -------------------—--------------------------------—-----------------------pp------------------------------- '=-----------------------------------------...._-•-----•----------•--------------------------------tY <br /> I herebycertifythat I have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances,XSfafelawsd rules and regulations of the San Joaquin Local Health District. <br /> (Signed].... (O an Contractor) <br /> - <br /> BY:-- -------------------------_ --•--------••--------- (Title)-------------------------------- --•---- --- - -- ----- ----- <br /> (Piot plan, lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -----------------------•----•-----•---------------•-•------ DATE-- f�'' °�°� -`)------------------------------ <br /> REVIEWEDBY------------------------------------------- -------------------------- ---------------------------------------- DATE----•-- - -- -•----•------------ <br /> BUILDING PERMIT ISSUED--------------------------------------- --•--- - • ---• ------------------------------------._ DATE__.-. --------­------------------------------------------ <br /> Alterations and/or recommend'ations:-------------------------------------- -------- -------•--•-------------------------------------•-_-•---------------•-----------•------------.............. <br /> -------------------------......----------------._.------------------------------------------------------------------..--------------------------------------------------------------------- ................................. <br /> -------------•---------------------•-----------------------•----------------------------------------------------------------------------------------------------•---•----------------------------------------- ------------- <br /> FINAL INSPECTION BY• � -------------------------- - Date--- 0. ~G--;------------------------------ --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT t <br /> I <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 <br /> Stockton,California Lodi,California , Manteca,Colifornla Tracy,California <br /> ES 9 REWSE0 a-59 2M 5-62 ATLAS <br /> ` r <br />