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�-UX UFFIC <br /> U <br /> A <br /> _f-J3 <br /> F ,� APPLICATION FOR SANITATION PERMIT Permit No. ------- <br /> -------------------------- <br /> ---------------------------- --------------------------- (Complefe in Duplicate) <br /> ---------------- ------------------- This Perm Date Issued <br /> --------------- This Per it Expires I 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 herein described. <br /> This application is made in compliance with County Ordinance No. <br /> 549. <br /> JOB ADDRESS OCAjT1N......,-_74_4---- <br /> ------------------------ <br /> Owner's Name---- ---- - -- - ----------- ----- ---- ---- ---- -- -------------------------------------- .... <br /> ------ if 3 � f --- --- Phon <br /> Address - - 4 <br /> .............- <br /> ---------- <br /> .. <br /> Contractor's Name .....----& _7L <br /> --------------P--h-o---n-e-] . � <br /> Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court [:] Motel Other 0 <br /> Number of living units: Lot size 0 / <br /> _/---- Number of bedrooms Number of baths _/__ _n57�2__x <br /> Water Supply: Public system 0 Community system El Private El Depth to Water Table•�O. ft. <br /> Character of soil to a depth of 3 feet Sand El Gravel 0 Sandy Loam L] Clay Loam [3 Clay [3 Adobeg Hardpan C] <br /> Previous Application Made: (If yes,date--------------------) Noo New Construction: Yes ❑ Nox FHA/VA: Yes Ej No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted public ubfic sewer is available within 200 feet.) <br /> �)A <br /> Septic Tank: Distance from nearest well&xp Distance from foundation-..49)..•------.Maters _61e­ <br /> /'. . , t <br /> No. of compartments---------- S i Z <br /> ------------ ��----Liquid dep*�h_..4/;�,_;Ev��aw ----•--Ca aci y--- <br /> Disposal Field: i- <br /> Distance from nearest well Distance from found-at' n&P........Distance to nearest lot lina�1_5_ V I <br /> 'T ......... <br /> Number of lines________ __ /Length of each line---� Width of trench--- <br /> J!, -Total length.....................!C�� <br /> Type of filter material.-&Y'.- e0th of filter material____-Z"I <br /> RI::1 <br /> t57Se e Pit: Distance to nearesteTr-�_ istance0m�Xndation.�O,_.Z_).......Wst nc? to nearest lot line................. <br /> Number of pits.__..__.-_________" ---- -------Size: Diameter--_,, t.............Depth------- <br /> 7 Lining material-- <br /> Cesspool: Distance from nearest well-___..____7_._.Distance from foundation--------------------Lining material............. ------------------------ <br /> ElSize: Diameter____"------------------------------Depf h----------------------------------------------------Liquid Capacity----------••--------•-------gals. <br /> Privy. Distance from nearest well-_.______________ _ ________._._Distance from nearest building------------------------------------ <br /> ❑ Distance to nearest lot line a_ <br /> 46n - - ----••-__-------- <br /> Remodeling and/or repairing (desc. ibe) <br /> r ...... lel ------ ----- <br /> ------------------------------------------------------------------ - ----- -- <br /> ------------------- <br /> -----------_-_------------------------ <br /> ---------------- <br /> ------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------I.................... <br /> ---------•-----------­------------------------------------------I ----------------1-1-1------------------------------------ --------I------------------------------- <br /> ------------------------------------------- <br /> I hereby rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, t lAws, d rules a r ulations of the San VJjo uin Local Health District. <br /> 09 <br /> (Signed)_-.--- ---------- ... <br /> .............. . .... ... <br /> ----- -- - ---- <br /> - --------------- --- ------------------ <br /> 0 <br /> _-g-j- 096wrier and/or Contractor) <br /> By:--------------_-----------.................. C,- 'I , il <br /> --------- - --------- <br /> ----­ ----- -- --------------(Title)__ <br /> (Plot plan. showing size. of lot, location of system in relation to wells, buildi ':s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- <br /> ------------------------------------------------------------- DATE------ <br /> REVIEWED BY------------------ IZA-L <br /> BUILDINGPERMIT ISSUED- ------------ ----------------I--------------------------------------------------- DATE----------- ------------------------------------------------ <br /> ----------------------------------------------­------------- ------------------ DATE <br /> Alterafiio%,and/or recd mendations <br /> _I - I . 4- --- -- ----­------------ <br /> _ -------- <br /> ..................... <br /> -------------------------------- --------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------.................................... ---------------------------- ---------------------------------- ---------------------------------- ---------------------------------------- <br /> ----­----------- -------------- ------------ ------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION . BY:----- ----------------------L <br /> ------------------------------- ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American street 300 West Oak Street 124 SYCOMort Street.. 205 WOO 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 RIVISEO B-59 2M 5-61 ATLAS <br />