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`4.FOR OFFICE USE: <br /> ------ ------------------------------------------------- <br /> -------- -- ----- ------------------------------ ------- APPLICATION FOR SANITATION PERMIT/ Permit No. ..2_12. <br /> ------- ---------- ­­--------------- (Complete in Duplicate) <br /> Date Issued .. ..... 11111-- <br /> ------------- ----- ----------r--------------------------- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor herein described. <br /> This application is made in compliance with County Ordinance No. 549 <br /> JOB ADDRESS AND LOCATION------------ ------------------------------------ ---------------------- ---------------------- <br /> ------ ------------------- <br /> Owner's Name--------mm_�_ __ e_�-—-------------------- --------------------------------------- Phone_,_-�_ <br /> Address----------- -------------------------------- <br /> ----------------------------------------------------- --------------- ------- ---------e----------- ------------------- <br /> 0 <br /> Contractor's Name-----_C-1-01 ------------------X-----------------J----••-------- ---------- -------------------------- .... ............ Phone---0""f Z.-Y 2 F_ <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel ❑ Other F] <br /> Number of living units: -------- Number of bedrooms Number of baths ---�Lot size <br /> Wafer Supply: Public system Community system El Private L] Depth to Water Table -------- ft, <br /> —Ch&i,ader of soil to a-d6pth of 3-foef:4-Sand Ej Gravel C] - Sandy Loam El Clay Loam E]= Clay-E] AdobeHard' _4pan-S <br /> x <br /> Previous Application Made: {If yes,date-------- --7--------) No Ne'w"Co' nstruction: Yes fid No E] FHA/VA: Yes E] No E] <br /> 1A <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic- tank or cesspool permitted if,public sewer is available within 200 feet.) <br /> : . / <br /> Se tic Tank: Distance from nearest weII_APgP0__ Distanc%from foundation----/I ____--._mater;al------e_14a------------- --------- <br /> No. of compartments...........4........... Liquid dep.fh---------- ---------Capacity---Z <br /> D;sp�o'al Field: Distance from nearest welL-AP00----Distance from,�%ncl ti n------ Distance to nearest lot line---- <br /> ed2 Re—rT3 0 <br /> Number of lines-------------�K-------------------Length of Midth of trench_.-__. _ --------- 0 <br /> Type of filter material----- --4-_.0f!P4-Depfh-of filter material-----/Ir-----------Total length---------- .............. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------�7---------- <br /> F-1 of pits---------- --- -------Lining material---------- ------------Size: Diameter-----L----------------- �t�CessPool: <br /> D. istance fromnearest well-- Distance from founclat�on.-------------- - ining materia ---------------------I-------- <br /> ❑ <br /> ----------Liquid Capacity----------------------- gals V, <br /> ---------------------------------------Dept h----------------------------- ------------ <br /> Pri ❑ <br /> __JSize: Diameter <br /> vy: Distance nearest well---------- --------------------------------------Dis'+ance from,'nearest buijd`in4------------------------------ <br /> Distanceto nearest lot I�ne--------------------------------------------- ------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe :-- --------------- ------------------------------------------------------- --------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- <br /> ------------------------------------ -------------------------------------------------------------------------------------------1-1---------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------- ---- ---------- <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 regulations of the San Joaquin Local.Health District. A <br /> ------- ------------ -----------------------------------------------------------------(Owner and/or Contractor) <br /> (Signed)---------6,61-4 <br /> BY:------eTa-91•---- ---------- -— ------------------------------------------------------------(Title)---------- ........ir------------- <br /> (Plot plan, showing size of lot, location�i 0...... 7_l$i;n relation to wells, buildings, etc., can be placed on reverse side). <br /> -Mrs te <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY----- ---------- -------------------------------------------------------------------------------- DATE--------------------------------------------------------- <br /> REVIEWEDBY---------------- ---------------- ------------ -------------------------------------------------------------------------- DATE-------- ; <br /> BUILDING <br /> ATE-------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------—-------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-------------------------- ------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------- -----------------­­-­------ -- ----------- ------------------------------------------------------------ ---------------------------------------I--------------f----------- <br /> ----------------------------------I----------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------- -- --------------------------------------------/------------------I------- ------------------------------------------------------------:1------------ <br /> ---------------------------------------7---------- -------- --- ---- - - --- --------------------------- ----------------------------------_-----------------:1------------ <br /> ----------------- <br /> FINALINSPECTION BY-------------- ---------- ----------------------- ------------ Date-------------------- ------- - ------------------------------------:t- --------- <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 B-59 3H 3-'63 F.F,Q0. 1,e,4*7_Zb <br />