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FOR OFFICE USE: <br />------------------ ------------------ ------------------ <br /> 4 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br />--------------------- [Complete in Duplicate),. a . Date Issued ---�Iti <br /> 1 t aS I- r0 -12 <br /> _ This Permit Expires 1 Year From Date Issued , <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install a work;herein escribed. <br /> This application is made in compliance with County Ordinance o. 544. <br /> y ,,ADDRESSAND LOCATION ---- -- ------- ---- -f-'--- --------- --- <br /> Owner's Name------U ---- ----- ------ ------- ---------------------- -------------- one-----•-----------------•- <br /> vk <br /> Address__.... " ----------- ---------- - ------------------------ ----------------------------------------- <br /> Con' <br /> --------------•----------------------- , <br /> ---- -- - - -- <br /> Con'tractor's Name--- .. \s� �' P Phone <br /> installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other <br /> Number of living units: -------- Number of bedrooms ___ ___ Number of baths -------- Lot size ______________________________________________...-____.____ ' f <br /> Water Supply: Public system ❑ Community system Private ❑ Depth tWater Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand [I -Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: {If yes,date-..____-.-:--------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.} <br /> SeptFc Tank: DisNot of compartmentsance from t-well-----------------Distancefrom foundatiLquid depth-_Material.--------_Capacity__-__-___.--..---._--I <br /> j,i= <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation_.--__---_..-_-__-.Distance to nearest lot line_________..____., <br /> of lines ------Length of each line------------------------------Width of trench----------------------------------- <br /> Number Type of filter material-------------------------Depth of filter material-----------------------Total length----------------------------------------- <br /> Distance <br /> -.---------------------------- -----Distance to nearest well___ .---___Distance fr fd ___ation _ __________.Disnce to nearest lot lin _____----------- <br /> --------_Linin material- __. --i__( ---v Size r_: /��.l�Depth-- --------------------- <br /> '❑ Number of pits_______/__._ g , <br /> Cessfpool: l Distance`from nearest well-----------------Distance from foundation--------------- _-Lining material-----------------------_--_-_-------. <br /> :❑ Size: Diameter--------------------------------------Depth-------------- ------ ---- ----- - -Liquid Capacity gals' <br /> Privy: Distance from nearest wef--------------------------------------------- <br /> ----Distance from nearest building----------------------------------------- <br /> Distanceto nearest lot line---------------------------------------:----- - ------------------------------------------------------------------------------------------ <br /> ll <br /> }} ------------------------------------------------- - <br /> N <br /> Remodeling and/or repairing (describe):__--------- -- ----------------- -----------••--------------------------------------- -- <br /> [ ---------------- -'� <br /> --------------------------------------------------------------•--------------------------------------- <br /> 1 ----------------------------------- f <br /> .f <br /> '= --------------------------------------------------------=-------------------------------------------------------------::----------- y <br /> `i I hereb certif { } I have prepared this application and that the work will be done in accordance with San Joaquin County y <br /> .- ;r_ Y Y P P PP <br /> ordinances, State Ia and rules and regulations of the San Joaquin Local Health District. <br /> i <br /> (Signed)------ --------- <br /> -- ------ a ------- -- ------ ------ - ------------------------------------------------------ ----------- -,e1(0QW9F=ftd/or Contractor) <br /> B ----- ----- ------------ ------------------=--------- -----(Title)--------- ---------------------------- ....... ------ <br /> [Plat plan, sho i g size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). <br /> 3 FOR DEPARTMENT USE ONLY <br /> �., <br /> APPLICATION ACCEPTED BYE - --- --------------- •----------------------- DATE ' <br /> i REVIEWED BY----------------------------------------- --------------------=-'--- ----------------------------- DATE------------------------------------------------------- <br /> REVI <br /> PERMIT ISSUED-i-1------------ '.'. # ---- DATE--------------------------- ---- --- <br /> „, �. <br /> Alterations and/or recommendations:--- ----- ------------------ <br /> --------------------••-------------------•---------------•------•----------------------------------------•-------------- <br /> - <br /> IE _ <br /> ------------------------- w, i. <br /> Il # ' ------------------------------- <br /> ­--------------------------- <br /> = "` ---------------`- •- --------------------------------------- <br /> ------------ ---- <br /> _ -- y i --- -------------------- ------..-------------------- <br /> ! t <br /> - `" _`-- <br /> FINAL INSPECTION BY. : = �"'� Date <br /> _x, SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> l 1601'E.Haxelton Ave. 300 West Oak Street_r _ 124 Sycamore Street .--�`� 205 West 9th Street <br /> 'Stockton,Callforn1c •'— . '.r_. Lodi,California Manteca,California Tracy,California <br /> ES 9 REVI6E6 8-59 3!A 3-'63 F.P.0 D. Yy <br />