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r%_om %jrriLr UZ)t- 0 <br /> ----------------A--------------------------------- - <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..... ................. <br /> ------------------------------------------------- (Complete in Duplicate) <br /> ""#------------------------------------------------- --- This Permit Ex fres 1 Year From Date Issued ------......... <br /> Date Issued ---:5 <br /> Application is hereby made to the Sian Joaquin Local Healfh 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 AND LOCATIO 1 —2 C <br /> 2�LOCA N__.L- -- ---- ---- 0 <br /> Owner's Name__ _447)._4----------— ------------•"--""""-......-----•-••.................. <br /> - ------------- <br /> Address------------ - ------------------------------------------------------------------------------------------- Phone................................... <br /> Contractor's Name --------------------------------------------------------------------------------------------------................. ..................... <br /> -------------------------------------------------------------------------------- ----------------- Phone---•.......--"--•-••"-•-••--"---•-" <br /> Installation will serve: Residence EV�partrnent House 0 Commercial El Trailer Court [:] Motel 0 Other E] <br /> Number of living units: ...I--- Number of bedrooms ---)--- Number of baths --!-. Or"10-0 <br /> -_ Lot size ..Ord Supply: Public system •W__&,_�rnun'fY system El Private [:1 Depth To Table <br /> I _0 ft. <br /> Character of soil to a depth of 3 feet: Sand [I Gravel,E] Sar <br /> I -idy Loam 0 Clay Loam E] Clay ED Adobe Er"Hardpan E] <br /> Previous Application Made: (If yes,date-- -----------------) No New Construction: Yes-E57-N— " <br /> 1 0 El FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool peimiffed if public sewer is available within 200 feet.) <br /> I <br /> Septic iod- Distance from nearest well--'"'--_7.-Distance from founclafion.-A-_f--------- riot___._-_ <br /> A <br /> No, of compartments------2— ---- ---------------------------- <br /> Disposal - -------------Size------ Liquid depth-,- •�op...............Capacity-10C <br /> .Field- Distance from nearest welJe-#jx.i%-t <br /> E)ist,,C, from foundation__ ...........Distance to nearest lot line..______...._(3 <br /> Number of fines.__',_j f <br /> -- ------ Length of each line---4--0-----------------Width of trench__A_jK <br /> Type of filter material------- Depth'of ia L k................Total length----- <br /> Seepage pit: -- ----- filter mate,* ........................ <br /> -a tv <br /> Distance to nearest well-!! ,---------Distance.fLQrn foundation----1-0------ D- farce to nearest lot line. ...... <br /> Number of pIts______ _________ <br /> I -----Lining material,__7 OP!;-4_Size: Diameter_ '_- Depth-----Z.57/�--------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-- <br /> ------• <br /> El Size: Diameter-------i------- -----------------------Depth----------------------------------------------------Liquid Capacity--_ ---------------------- <br /> -------------------gals. <br /> Privy: Distance from nearest well-------------------- ----------------------Distance from nearest b0cling-------- <br /> Distance to nearest ------------------------------ <br /> lot line <br /> Remodelingand/or repairing (describes____________________------_------------------------? ------------------------------------- ----------------------------------------------------------------------------------- ---------- <br /> ------------------------------------------------------------------i ---------- <br /> :-------1------------------------------------------------------------------- <br /> ----------_----------I----------------------------------------- . ------------------------------------_ ------ ---------------- <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 laws, and rules and re atio of the San Joaquin Local Health District. <br /> t <br /> (Signed)-----------*­----------*------------------------- - ---------- - ----------------------------------------------------------------- --------------(Owner and/or Contractor) <br /> By-—--------------------­---------- -------------- --------------------------------------------------------(rifle)---------- <br /> E ----- <br /> --------------------------------- <br /> (Pic+ plan, showing size of ocafion ?f system in ings, etc., can be placed on reverse side). --- <br /> ia�fion to wells, buildings, <br /> FOR DEPARTMENT--USE—ONLY <br /> ------------------- <br /> APPLICATION ACCEPTED BY__-_- ___-: -----__ <br /> _--------------- - ------------------------------ DATE----- ............ ---------REVIEWED BY ------ <br /> B - - DATE------------------------------- -- -UILDING PERMIT ------ --- - -------------- <br /> ------------------------------------------------------------------ DATE---------------- <br /> Alterations and/or recommencptions:--- ----------- <br /> --------------i---/... ---------------- ---------- <br /> ----- ......... ----- ----- ------- <br /> ------------ - ---------- <br /> --------------------------------------------------------------------- ------------ -------------------------------------------------------------------------------------I-----------------------iI--------- <br /> --­--------------------- -----------_----------------------------I ---------- <br /> ---------------------- -------------------------------------I--------------------------------------I------------------------------------------------------ <br /> -----------I------------ ----------------------------------- ------I- <br /> ----------------------------------------------------------------------------------------------------------- <br /> -- ---------------------- <br /> FINAL INSPECTION BY:.-_--- - -- - ----------- --------------- ------- Date....... <br /> 1)SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American street 300 West Oak Street <br /> 124 Sycamore$front <br /> Stockton,California Lodi,California 205 West 9th Street <br /> ES 9 REVISED 9-59 2M 5-62 ATLAS Manteca,California Tracy,California <br />