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FOR OFFICE USE: <br /> ------ ------ Permit No. <br />---- --- APPLICATION FOR SANITATION PERMIT <br /> ---- ------------ <br /> , 30 Duplicate) <br /> (Complete in Date Issued ----4.-'- <br /> ------- -------- <br />- -------- ----------------- This Permit Expires I Year From Date Issued <br /> ------------------- described. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desr <br /> This application is made in compliance with County Ordinance No. 549. <br /> — W � ------ --------------------------------------------------------------------------------- <br /> ­30,5 _4 ---- -------------- <br /> JOB ADDRESS AND LOCATION____ ----------I---------------------- ----------------- Phone------------------------------------ <br /> Owner's <br /> hone----------------------------------- <br /> Owner's Namel...... �ci--- ------------------------------------------------------------------- ---------- <br /> --------------------------- <br /> Address---------------- --- ------•---------------------------------- ------7 <br /> Contractor's Name------------C�_, -------- --------------------------------------------------------------------------------•--------- Phone-------- ------------- <br /> Installation will serve: Residence JE- Apartment House El Commercial [] Trailer Court [I Motel 0 Other E] <br /> Depth to Water Table _-4ft. <br /> I / ?�6--------------------------------- <br /> Number of living units: J--- Number of bedrooms -,Z.- Number of baths size --- W_X-_-------- <br /> 4 <br /> Water Supply: Public system Ur—Community system El Private [] I <br /> Character of soil to a depth.of 3 feet: Sand 0 Gravel El Sandy Loam 0 Clay Loam 0 Clay 0 Adobe�arclpan C] <br /> Previous Application Made: (if yes,date____________________) No � ,New Construction: Yes ff"'No E] FHA/VA: Yes [j No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if'public sewer is available within 201:74eei.) <br /> --------------------- <br /> f6undation/0.1-----------Materiac A7!5� C/ <br /> Septic Tank: Distance from nearest well-—-------Distance from 0 y---- _4 <br /> No. of compartments-.---.: <br /> Size---3__�KA -9---------Liquid 'dep�h___-f-- ---------------Capacif <br /> P <br /> Disposal Field: Distance from nearest well_.':?7 -- -ti._ from foundafion_ ­�-----1,-----Distance to nearest lot line__�$_ ' <br /> __ <br /> ?7 - /# ... <br /> Z4 A -- <br /> Number of lines---:-I------------- ------;^Length of each line----9_0. .............F--"".Width of trench----0 ---- <br /> -------------- <br /> 211� Type of filter maferiaC71 &.(J�-----4__be�pth of filter maferial-le ----Total length------76--------I---------------; <br /> _J- <br /> r I <br /> Seepage Pit: Distance to nearest well-.----—-----------Distance from founclationM.&9 J;-----------Distance to nearest lot line---�O------------ <br /> --------------- 0 <br /> (7 met�r-_�3­3_4---------Depth---of pits.____-(-------------ILining •material- I -:-.--.Size: Dia Vill <br /> R_ $ from foundation i I I Lining material____.____________.___..__________..Distance from nearest well-!_______________Distance ----------------- <br /> -------------------------gals- <br /> El Size: Diameter----------------- ----------- ------Depth ---------- ---- ----Liquid Capacity <br /> Privy: Distance from nearest well- <br /> Di-siance from nearest building------------------------------------------ <br /> Distanceto nearest lot line-1 --------------------------I-------------------------------------- ------------------ ------------------------------------------------ <br /> ----------------------- <br /> ---------------- --------------; <br /> Remodeling and/or repairing (describe}:________'__- ------------------------ -------------------------------- - --------------- <br /> ----------------------- -------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------- <br /> ------------------­--------------- I ------- <br /> -------------------------------------------- -------------------------------I----------------I- <br /> -------------- <br /> -----------------------------------------------------------------------------7------ ----------------- I <br /> - i I I <br /> ----------- --------------------------------------I -------------------------------------- ---------------------- <br /> ----------- --------- ----------------------------------------------------------------- <br /> t* <br /> I hereby certify that I have prepared this application <br /> an <br /> t on d that the work will be done in accordance with San Joaquin County <br /> J" I <br /> ordinances, State laws, and rules and regulations of he S an quin Local Health District.' <br /> (Si --------------------------------------------"-In---_I- <br /> -----l-e--)-------- <br /> - (owner and/or Contractor) <br /> ------ --- - - <br /> g .(Tit <br /> ------- - -- --------- <br /> By:--------------------- -------- <br /> (Plot plan, showing size of lot, location of systemin re[afi6n'to *ellsl-buildings, etc., can}be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY I <br /> - --- <br /> - --------- ------- --- <br /> ---- DATE- ------ - ------------ ------------ <br /> APPLICATION ACCEPTED BY-- --- ---------------- ------------------------ --------------- <br /> DATE------------------------------------------------------------ <br /> REVIEWEDBY--------------------------------------------- - - <br /> ---------------- <br /> BUILDING PERMIT ISSUED--------------------------------- ------------- -------------—----------- ----------------iDATE ------ <br /> ----------------------------- <br /> 0 .a <br /> ------------------ ---------------------------------- <br /> Alterations and/or recom'mendations:-- <br /> - <br /> I---�; ) <br /> --------------- <br /> ---- <br /> --------------- ---------------------------------- ----------I------------------------------------------------- <br /> -------------------------- ------------ <br /> ------------------------------ ------------------- t ------------ <br /> TF ------------------------------------------------ <br /> - ------------------ i---------------------------------------------------------- ----------- ------ <br /> fI I ----------------- -------------------------------- ---------------------------------- <br /> -- --------------- <br /> ------------=----------------------- --- <br /> ------------ <br /> i i ---- ------------------ --------------------------------------------------- <br /> --------------------------------- ------ -------------------------------- ----- ---------------------- -------------------------------- <br /> _7 ------------------------ <br /> -------------------- -------- - ----------- ----------- <br /> FINAL INSPECTION BY:------ - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S-59 SM 3`63 F'F"C[2' <br />