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£FOR OFFICE USE: � ....... <br /> r <br /> �l Y ---------------, r r <br /> Permit No. ../.._ <br /> -------.1�,-.3G--. APPLICATION =AOR SANITATION PERMIT / ---•---- <br /> -------------------------- ----------------------------- (Complete in Duplicate) <br /> This Permit Ex`'fires l Year From Date Issued <br /> Date Issued ... ...... . ... <br /> - ------------ <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. 549. <br /> - s ________________________ <br /> JOB ADDRESS A TION--- � --- ? _ --------..-- -`,- -•---•----------•--••--------•- <br /> Owner's Name-__ �_ \• =- <br /> Phone-----------•--_------------------ <br /> Address_........ <br /> --------=--- <br /> ----�* ._____1"5____­ <br /> ----------- <br /> L . •-- ••..............................•-------- <br /> Contractors Name--•------ ---------------------------------------------------------..-------------------- Phone----------------------------------- <br /> Installation will serve: Residence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other f❑ <br /> Number of living units: ____... Number of bedrooms_____ Number of baths -Lot size ..M/- f-.�- - },/ ' <br /> Water Supply: Public system ❑ Community system Private ❑ Depth To Water Table 6.5ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dy Loam ❑ Clay Loam ❑ Clay E] Adobe iardpan C1Previous Application Made: (if yes,date- --------------) No [Et Construction: Yes No ❑ FHA/VA: Yes Fio El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r' <br /> . y <br /> 1 <br /> Septic nk: Distance from nearest well___,r _..Distance from foundation___1 _._...__.Material__ l.L�-------•--- <br /> No. of compartments-------=-��--------Size---.,��"--x_��-•------Liquld depth_�s-�--------••--Capacity------ ---------••--- <br /> DispTos�field: Distance from nearest•,eH':,- .-Distance from foundation,. ...�..�-.....Distance to nearest lot line._ <br /> LId' * �3-- -----.Width of trench._s�_.� _#--•-•--•--------. <br /> F Number of lines------�`�=--------------- ---Length of each line_____. 7 <br /> jj <br /> Type of filter materiklJ-)1 4—e�&'K'_Depth of filter material__ .-p----------Total length___. _ __�________________________ pq <br /> jj ----- <br /> Seeps Pit: Distance to nearest well___ sta tom ndation__f.. _ '`.Distance to nearest lot Ii�r ...- 1N <br /> ,-- ..Size: Diameter___ De tl, _.rr <br /> Number of Its------- _ --- Linin mat r p <br /> p �l'1. --.,4 <br /> 9 <br /> 3 Cesspool: Distance from nearest well--,--,-,___________ ' tante fro oundation--------------------.Lining material_-.---.____._-_----.._--__---_-.----_ <br /> M <br /> 1 ❑ Size: Diameter._ "' ------------------Depth----•--•---•-------- --------- Liquid Capacity gals. <br /> Priv Distance from A arest <br /> Y� �. <br /> 't we1L`. 1Distance from nearest building i. <br /> ❑ Distance to nearest lot.dine---- -------------- }'- ------------- --•--•- `------ --------••---------- ----- ---•-••----------- ------------------ 0 <br /> Remodeling and/or repairing (describe): ._..., - -•------------ ...:. <br /> -------------••----•--------------------•---------------------------•---------•-•-----------------------------•------•---•-----• - <br /> -------------------------------------------------------------------- -------------- ---------------.--------------------------------------------------------------------------------------. ----•--•--•------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law , d rules and ations of the San Joaquin Local Health District. <br /> (Signed).... •----- Owner and/or Contractor) <br /> ------------- Title --.C�/-f1.1 ... ------------ <br /> (Plot plan, showing size of t location of system in relation to wee . uildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------•-------"------f ' ' ----------------------------------------- ---- DATE Q--__'' '==a <br /> REVIEWEDBY-_----------- ----------- - •-•--- ----------- ------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------- -------•---------------------------------------- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendafons -------------- ------------•----------------- ------------------ ----•----•-----------------•----------------•-•------------------------------------------ <br /> OW----------- '-�----•----------•--------•-----•-------••-----•-----------•----------------- <br /> -- - -- '- -- -••---------•-•----------------••--•--•--------------•-•------------•-- <br /> - ------------ <br /> - <br /> ------- - L s!-- j... r <br /> `l -------------------------------------------- --------•--------- -------------•-•------------ <br /> t9 --- <br /> Date <br /> -- <br /> Date. r �` <br /> ------------ - _---- -F1NAL INSPECTION BY: . ----- t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />