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FOR OFFICE USS <br /> -----------Il l f(i �- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .................... <br /> (Complete in Duplicate) Date Issued <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 descrbed. <br /> This application is made in compliance with County Ordinance No. S49. <br /> i' <br /> JOB ADDRESS AND LOCATION-----175on-----------SSW it�s' '- ------------------------------•-------- --- � ..........--------•---_.--__... <br /> Owner's Name--------el__Csk��-------�4:77- --------------------------------------------------------------- ------------ <br /> •-----.----•- <br /> Contractor's Name. r14� /5'i "/2 }S ¢� C� r Al r- -------------------- •........ Phone/a�_...k.?,tho.7--- <br /> Installation will serve: Residence 12,"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [INumber of living units: __,r_. Number of bedrooms .-_f Number of baths __./- Lot size .._.- _ �x._/��..-.�--------•----- <br /> Water Supply: Public system EKtommunity system ❑ Private ❑ Depth To Water Table _....__. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam I'Clay ❑ Adobe E!r'-H-ardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No FT�_New Construction: Yes ❑ No [ FHA/VA: Yes ❑ Nom' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: A./ I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t 1 <br /> Septic Tan6: Distance from nearest well_________________Distance from foundation-------------------Material--------------------- ..........._____.________- <br /> No. of compartments--------------------------Size--------------------------------Liquid depth_--_--------------------Capacity----------------------- <br /> • "... <br /> Disposal F�_ Distance from nearest well���._Distance from foundation_______ ___________Distance to nearest lot line___:.].......... <br /> Number of lines-------------- Length of each line--------Ja............-Width of trench-----._....2_,S---"--.------_ <br /> __ <br /> 1- <br /> Type of filter material-_-�?r_4!-J4______Depth of�filter material -_--io _"_-..._Total length________- _______________ <br /> Seepage Pit- Distance to nearest well_____________I-____-Distance 4rom (foundation----------------_..Distance to nearest lot line........:....... ► rn <br /> ❑ Number of pits----------------------Linin <br /> g material-------------:----------Size: Diameter---------:--------------Depth--------------------------------- . . V► <br /> F <br /> Cesspool: Distance from nearest well---------- from foundation..._'-.->'-------Lining material------------------------------------- <br /> Size: Diameter - -.De th Liquid Capacity---------------------------•gals. <br /> ❑ p <br /> Privy: Distance from nearest well-_________________________________._._ _-_____Distance from nearest building______._____-__-____-_________._.-..___._. <br /> ❑ Distance to nearest lot line--------- ---•--•--------- - ---------------------------------------------------•---------------•-----....------------•---------------------- <br /> T <br /> Remodeling and/or repairing (describe):________�,eeP___--.;W._- X! It It _......�_ -------------------------------------- <br /> ----•-•--•-----••-•----•----------•---•----------•-•------------------------------••--------------------•---------------••--•---------------••------------•--------••--- •-------------------------•------------------------- <br /> 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. <br /> __�2 r._--- -- 3---- - A - ' - ----- `-----------------------------(Owner and/or Contractor) <br /> (Signed)-------------- - - d� <br /> __ t 1­1Title <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------C--- - ----------------------------------------------------------------- DATE-- ' } -r— <br /> REVIEWEDBY--------------------------- •---------------------------------- ------------------------------------------- ----------------- DATE------------------ �---....------------- ---_------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------__------------ ------------- DATE--------------------- ------------- •--------------------- <br /> Alterationsand/or recommendations:----- ------------------------------ -------------------- -----------------------------------*-----------------------------------------------*------- <br /> -•--------••--------------------------------------•-•----------------------• - ---------------•--------------- ------------••-----------.....-------------------------------------------------------------------------------- <br /> ------------------•-•----•---------------------------------------------------------------------------•------------------------------•-•----------- -------------------------------- ---------- --..._..-------------------- ,• <br /> -----------------------------------•--•---------------------- ----------- ------------•------------------------------------------------------------------------------------------------------------------------------ <br /> { 1 <br /> FINAL INSPECTION BY: Date------ ------- •-- ----- - ---- - -- ------ <br /> SAN JOAQUIN LOCACHEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodl,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />