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� FOR oI>_ s � <br /> 3 /� <br /> APPLICATION FOR SANITATION PERMIT Permit No- .. 1._____. 5! <br /> ................ ---------------------------------- (Complete in Duplicate) / 7/ <br /> ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> 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 /> JOB ADDRESS AND LOCATI N•`------------- t�----------- ----------------------------------------•--------------••--------------------------------- <br /> Owner's Name --- - -- ------------------__-_-_---•---- -- •------------------- Phone------------------------------------ <br /> Address-----�W,-t n�1--4:- ..,�-d-------------------'--•----------•-------- <br /> Contractor's Name- ------- .._ r-------------- Phone_,//a.-- <br /> Installation will serve: Zidence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1..... Number of bedrooms ---L. Number of baths .I-__ Lot sizeX�O_a--------------------------- •-_ <br /> Water Supply: Public system [!�Community system ❑ Private ❑ Depth To Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa y Loam E3 Clay Loam ❑ Clay Adobe�ardpan El <br /> Previous Application Made: (If yes,dote-------- _------) No FNew Construction: Yes %r I No ❑ FHA/VA: Yes ❑ No Z <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> • � ,► �( <br /> Septic nk: Distance from nearest wellll�i�t�---Distance from foundation----1,P---._......Material---�2----------------------------............. <br /> ---- ` <br /> No. of compartments-----L-----------------Size---alk"-'j-------Liquid depth------�,-/-------------capacity...;Va9 <br /> i <br /> Disposal geld: Distance from nearest well _'M0-A-ALDistance from foundation_10.............Distance to nearest lot lineti r_!..... <br /> E Number of lines-----t----------------------------Length of each line___--9_P..........c---__Width of french _----------------------- � <br /> Type of filter material_LA----------Depth of filter material_-_--/_$'.... -------Total length----1-Q--'----------------------------- <br /> Seepage Pit: Distance to nearest ---------Distance from foundation-r0.- Distance to nearest lot line---§---�__.._ <br /> Number of pits----f-----------------Lining material--�a_4A-----Size: Diamete r__-f,-3-c .R --__-.Depth---- J <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..-._----------_.----------_-------- <br /> Size: Diameter-- ----------------------------------De th----•--------------•--••----------------- <br /> ❑ I p ----------Liquid Capacity----------------------------gals' <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building------------._-...-.........------.--_-.-. <br /> ❑ Distance to nearest lot line--------- -••-----------------------------------------------------------•----------•--------------••--------------------------------------- <br /> Remodelingand/or repairing (describe):---------------------- -----------------------•-------•------------------------------------•--------------------------------•------------------.-------- <br /> F <br /> ------------------------- ------------------------------- ---_ <br /> I hereby certify that I have prepared is a plication and that the work will be done in accordance with San Joaquin County <br /> ordinances S ate laws, and rules and reg do of the Sa Joaquin Loca Health District. <br /> 5i reed �f�&�& <br /> C �""` `------------------•-•- Owner and or Contractor{ g l----------------------J ------- --- - -- ---- ----- - ----- - =� ---------- { / ) <br /> By:----------------- _-- -•----- --- -- ----- ----------- - --------- _ ------trifle)---------------------------------------.---..._..-------------- <br /> (Plot plan, showing size of lot, to of system in relati n to Is, buildingstc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- - - - ------------------- ---------------------------------------- <br /> DATE-_-_---__-1 <br /> -- -- --- ----- - •--- -•----------------------------• DATE------------------------------------------------------------REVIEWED BY <br /> BUILDING PERMIT ISSUED--------- =�'-ta`------- ''' � ------ DATE------------------------------- --- --- <br />' Alteratons ;- r <br /> I ------------------------------ <br /> ---------------.............. --•-•-------------------•------------•--------------------- -------------------­­­11----------------------------------------------------------------------------------------------------- <br /> E ------- -------- -•----------------------------------------------------------------------------------•------------------------------------------------------------------- <br /> f -3 <br /> FINAL INSPECTION BY:< - _ � -------------------------------- Date------.. � �Y <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wert Oak street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodir California Manteca,California Tracy,California <br /> t <br /> ES 9 REVISED 8-59 2M 5-52 ATLAS <br />