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FOROFF E US <br /> ---------- ---- --------- <br /> .................. APPLICATION FOR SANITATION PERMIT Permit No. .... <br /> --------------- --------------------------------------- (Complete in Duplicate) <br />---------------- -% 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 herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN9D40CATION------ ----- <br /> ------------- ------------------------ <br /> Owner s Name__._.__. <br /> Address <br /> ame-------- <br /> Address............. -- <br /> ------------------------ Phone.............................. <br /> .......... 7-Z4..........5h 4-, <br /> r ----------------------------*---------------------- <br /> ---------------*-------------*------------*—-------------------------------- <br /> Contractor's Name....___.DO, <br /> ------------------------------------------ Phone........ <br /> Installation will serve: Residence ElApartment House [3 Commercial El Trailer QiLrt [] Motel [I Other 0 <br /> Number of living units: Number of bedrooms'-?k. Number of baths /f size <br /> Water Supply: Public system 0 Community system E] Private ®/5-epth Water,.Table47rft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel C]- Sandy Loam Clay Loam Clay [j Aclobe4�ar <br /> �/Co cloan 0 <br /> Previous Application Made: (If yes,date------------ -------) No OkII-New Construction: Yes FHA/VA. Yes El No Pg--, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fek) <br /> Sppfic T Distance from nearestA6 rl C <br /> ­- -Distance from foundation--------------- <br /> El" No, of compartments_.- _'_'?. <br /> Disposal Field: --_________Size_--__...-iLiq u id;d ep.fh------- -----_Capaci <br /> Distance from nearest well___._-___Distance from foundation .....Distance to nearest lot line_S...... <br /> Number of lines----------r------9;r-----------Length of each line____,`_. ----_---.Width of french. <br /> Type of filter material-_---- of filter material! 01-f-----_--Total <br /> -14--------Total length.___. ---------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation..____...____.......Distance to nearest lot line_________________ <br /> Number of pits.__.________- -------Lining material-A�- '� -'-Size. Diameter___ Depth----:f!7::C <br /> Cesspool: Distance from nearest well--/ -------- <br /> .k--V....Distance from foundation.---- -----__-_Lining material-------------_f------- .......... <br /> ❑ Size: Diameter--------------------------------------Depth---------------------- ----------------------------._Liquid Capacity............................gals. <br /> Privy: Distance from nearest well------------------------------------------N----iDistance from nearest building----------------- <br /> 0 Distance to nearest lot line________________________________- ----------------------- <br /> ---- ------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------------- <br /> ------------------- <br /> ..................-------- - ---------5...... ------------------------------------ -------- -------------- ---------- ------------ ------------------------------------------------------- <br /> k <br /> --------------------------------------------------------------------- ---------------------------------------------I--------------------------- <br /> --------------------------------------------------------------- <br /> ----------------------------------------------------- ----------------------------------- --- ------------ <br /> --------------------------------------------i ...... -------------------------------------------------- <br /> I hereby certify that I have pre" this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la a rule gulaflons; of the San Joaquin Local Health District.' <br /> (signed)-------•------- --------- ----------------------------------------------- (Ownerand/or Contractor) <br /> By:-------------------------------- <br /> (Plot plan, showing size o ocaf ion o sy ern in relationto wells, buildings, etc., can beplace <br /> f I ------ ---------------------------- ------- laced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED .BY___._____4�/------ ------ --------------------------------------- DATE------- <br /> REVIEWEDBY........................................ ------- ----------- --------------------*--------- DATE.... --- ---- --------------------------- <br /> -------------------------------------------------------- <br /> BUILDING PERMIT ISSUED__..-------------------------------------------------------------------------- --------L.- -------- DATE•...----------------------------------------------------------- <br /> 7-��------------------- <br /> Alterations an or recoMMendations:-------- <br /> ----------- ---- ---------- <br /> (---------- <br /> - ------------------------ <br /> ��o----------- --------- <br /> . ......... .... ---------- <br /> ----------- <br /> -------------------- ---- - --------- <br /> ------------- <br /> - ------------------------------------ <br /> ---------------------- <br /> -----------1119� <br /> -------- ----I-- --------------------------------------- <br /> ------------------------- <br /> -- ----------------------- <br /> !:�INAL�INS4 �TlnN BY:--------/ <br /> -------------------- ------- ------- <br /> JAOQ U I ------------ <br /> IOCAL HEALTH'A` <br /> 130 South American Street <br /> 300 West Oak Silr4jt I---Or 1 124 Sycamore Stwet205 West 9th Street <br /> Stockton,California Lad],California Manteca,California <br /> -61 ATLAS <br /> EB 9 REVISCO B-59 2M 5 Tracy,California <br />