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FOR OFFICE USV� ,,„ <br /> APPLICATION FOR.-SANITATION PERMIT Permit No. .I._______!-�/ <br /> -- ---- - ---- --•------•---------- (Complete in Duplicate) <br /> Date Issued --------------•--� �---- <br /> 7-/-/-_7____ -----------e& --------- This Permit Expires 1 Year From Date Istued <br /> q�Alp} icati is 're mAdso hle"*�An Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is ' de i compliance with County Ordinance No. 5 <br /> JOB ADDRESS AND LOC TION---- ----OV �. ------------------------------------------ <br /> -- ------ ---- ------------------------------- <br /> ' Owner's Name--- .... . . --. ------------------------------------------- -----------------•-------.----------•-------------Phone................................... <br /> Address............... s - .......... <br /> -t�---- <br />' Contractor's Name_.._.. _. = ........ Phon <br /> I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 5;9- Number of bedrooms _7--... Number of bath_-_ Lot size ... Q_: ___:___--•__.:--_-___ <br /> Water Supply: Public system ty y .. ❑ ❑ p * ,- � �'^� ' <br /> [�Commurii s stem: Private De th�to Water Table`.�.-�f+. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑., Clay.Loam ❑ flay ❑ .Adobe lardpan ❑ <br /> Previous Application Made: '(If yes,date_�___________-------) No E] New Construction: Yes ❑ No'g?-fHA/VA: Yes'E] No ❑ <br /> j TYPE OF INSTALLATION AND SPECIFICATIONS: "4 , <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee}.) ` <br /> t c Distance from nearest well_________________Distance from foundation--------------------Material_-_---.._.-....'_................................. <br /> No. of compartments t----------------------•-Size-------- •'--- -•---i Liquid depth-------------------------Capacity----------------------- <br /> pos Id: Distance from nearest well---- _____________Distance from foundation--------------...__.Distance to nearest.lot line................. <br /> Number of lines------- <br /> ----------------------------Length of each line-------------------------------Width of trench-___-,___-___._..-.___------------- <br /> r Type of filter material _._..___._-Depth•of filter material-----------------------Total length:-----..____________-________---•__--___-- <br /> Seepage Pit: Distance to nearest wtI . . . .............Distan r m f ndation_ Q-�__3istan;e to nearest lot line, l._[K Number of pits____._-_-_____Lining material.--: -Size:-Diameter__ Z-____. ___, p <br /> = De th r ------------- <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 /> ❑ Distance to nearest lot I r _ -------------- --------------- <br /> Remodeling and/or repairing describe : <br /> F --�jzw...-- -------- -- -- - • __....-•-•----. ..--------------------•--- <br /> r } <br /> _. y - ._.. <br /> ------------------------------- <br /> a_ <br /> ------ --------------------------------------- ------------------ ---------------------------------------------------------------------------:Z=:--------------------­------­------I....... <br /> I hereby cer+ify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and-rules and,regulations of n Joaquin ocal Heal District. <br /> fir, <br /> (Signed)------------ - -_ -----------(Owner and/or Contractor) <br /> By:-------._ -- --- ---- ---- ------- (Ti+le) --------------------------------------------------------- <br /> (Plot plan, showing size of lot, locatio system in relation tti rrells,'buildings, etc., can.be placed on reverse side). <br /> FOR D PARTMENT USE ONLY I <br /> DATE <br /> APPLICATION ACCEPTED $Y------ <br /> -------------------------------------- --- --.------- <br /> - DATE.----' --��' _. <br /> REVIEWED. BY... DATE <br /> • ----- <br /> .. <br /> BUILDING PERMIT ISSUED............... = _ �.'. -•� `' DATE.'• ...._ <br /> Alte 'o and or recommendations:-------.------.-_- I <br /> ---- ------------------------------------------------ -----------•------------- <br /> ... .... ......... ..._ <br /> --- _ ---______________-____......._____________-----.--___.-_- <br /> _ IV _ <br /> ` r W <br /> I - -------------------1-------------------- ------•----• -• .... <br /> il'`v <br /> FINAL INSPECTION BY:....... --- Date----------p. <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 T Manteca,California Tracyr California <br /> r E8 9 REVISED 8-69 2M 6-61 ATLAS <br />