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t-UKUh-HCE U5E, � <br />-------------- ----------------------- ----------- ---- _ <br />.................................._...-.___.----.....G APPLICATION FOR SANITATION PERMIT Permit No. ._�.�._�`!l <br /> . (Complete in Duplicate) <br /> 'l Date Issued ...y.�...6 <br /> _._ . <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 /> O ADDRESS AND'AlcLOC TIi' _ ` <br /> �N ,y `---��'--- X)---�`�� .--------- :._.f' ��............. <br /> Owner's Name.. <br /> Address............. ------------- f <br /> Contractor's Name•... 'yt-�_ ----------- ------­---------------------- <br /> ,��- ---- -------------••----------•--------•---............----•-•--•-.. Phone....-...•-.-.................. <br /> ...... <br /> Installation will serve:-leid ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3Other [I <br /> Number of livin9units:._1...-- Number of bedrooms ---� Number of baths ._�_... Lot size ._.-�.1�.....�.:................................ .. <br /> .r . <br /> Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ?'A. ft. <br /> Character of soil to a depth af13 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ Hardpan j <br /> Previous Application Made: ilftyes,date--------------------) No 0 New Construction: Yes X No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> Septic Tank: Distance from nearest well_,96__p--------Distance from <br /> foundation---/0-.--•••._.Material <br /> . ................... <br /> ® No. of compartments_.-._ •----------------Size_T�t1.'.-_--_.--.Liquid d ----------.------Capacity/ <br /> ......... <br /> Disposal Field: Distance from nearest well.-4—P Distance from foundation..Z°......_...-Distance to nearest lot line..4........... <br /> Y Number <br /> e of fil:lines-----L-------------•------- --Length of each line----t--....-._---------.Width of trench__e?�cZr--•----------------.---- <br /> er material __,.d7 -_-Depth of filter material..../...-_-......Total length___., ......................... Q ! <br /> ,l f • - <br /> - <br /> Seepage Pit: Distance to nearest well-.1GT-----------Distance from�*foundation_f_•_..............Distance to nearest lot <br /> ® Number of:pits_._..1---------------Lining material.kIt" ...._---__.Size: Diameter_.,_!.............Depth_ ---------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--.,---------------- ...-.......Lining material..-...-_- -I--------------------_-_ <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-------•-------------..._...gals. <br /> Privy: Distance from nearest well------------------------------------_--.- --Distance from nearest building------------------------------------------ <br /> F1 Distance to nearest lot line----------------------•---- <br /> ii <br /> Remodelingand/or repairing (describe):--------------------------------------- --------------------•---...-----------•-------........---------------•----------•--••---•-------------•--------- <br /> 5 <br /> I: <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, St to laws, and rules and r gulatioQs of the San Joaquin Local Health District. <br /> . _--towner and/or Contractor) " <br /> (Signed)--•--- ---------- ---------- -,.. <br /> �Y• -----•--------------- ------------------------------------------------------•------••----------{Title).------------------ ------------------------ - - --------------- <br /> _ <br /> (Plot plan, showing size of lot, loco#ion of system in relation to wells, buildings, etc., can be placed on reverse side). ` <br /> ,i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY—AA--- - ----------------------------------------------------•---- DATE........ -6~[ .��------------------------- I <br /> REVIEWEDBY !l•---------------------------------------------------------------------------------.............. DATE-------- <br /> BUILDING PERMIT ISSUED......'`•-------------------------------------------------------------------------------------------- DATE <br /> Alterations and/or recommendations:--------•- ---------------------------------------------------------------------------------------------------- r <br /> li " <br /> ----------•-----------•----------------------•----- ---••------------------------------------------- -----------------------------------------------------------.---------------------------------------------------------- <br /> ..• <br /> .............. --•------------------------------- ` ----------------------------------------------------------- <br /> -------------•---------------•---------•--------------------•---------.-...._.-- <br /> -------------------------- ...... ---------'----------------•------•---------•------------------------------------------ --•------------------• ------------------•-----•---•---------• -------------------------- <br /> ll <br /> FINAL INSPECTION BY• ---------------------------------- Date---- -------- ------------------ <br /> II <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street II 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California i Lodi,California Manteca,California <br /> Tracy,California <br /> ES 9 REVISED H-99 ZM 3-61 ATLAS 'I <br />