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4. <br /> FOR OFFICE USE # "= - AR115,9 <br /> --_----- __.7t 1_ APPLICATION FOR SANITATION PERMITFPermit No. /�1 = L —-- 1 (Complete in Duplicate)--- - � = ( P P' ) Z/�3 <br /> -------------..........................._.----.--_--..__. This Permit Expires 1 Year From Date Issued <br /> Date issued __...?_..._ ___&.Z' <br /> Application is hereby made to the San Joaquin.Local Health District for a permit to constrt{ct and install the work herein described. <br /> This application is made in compliance with Coun 1 e o. <br /> f <br /> -- -------. <br /> JOB ADDRESS AND LOCATIONJ�Z1.- _!F ",�.L ll� Ad__ .���',ll�e��??.- • . --------- <br /> Owner's Name / !C� -a� -------------------------------------------- <br /> F� ----------------•--- Phone.......................... -------- I <br /> .._....-- �'_ <br /> = <br /> ---------------- -- i <br /> ------- ------•------------ <br /> Address---- <br /> Contractor's Name.`..._.. .- ..-- Phone---------------------------- <br /> -----• -------------------__---------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court 2 1V otel ❑ Other ❑ \ <br /> Number of living units: .'__"_ Number of bedrooms --------- Number of baths -------- Lot size ------------------------------------------------------------- \ <br /> Water SuPPIY= Publics stem ❑ CmmunitY system ❑ Private Erl6epth To Water Table brit <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑\ II <br /> Previous Application Made: (If yes,date-------------- -----) No 120" New Construction: Yes 9?'No ❑ FHA/VA: Yes ❑ No gI. - <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: s g <br /> No septic tank or cesspool permitted if public sewer is available within"200,feet.] Material-- - r <br /> Septic Tank: Distance from nearest well__$ _- Distance from foun�atio ♦ /� f ' - ° t ~J '� 5 <br /> { P • P P ,�/ j _ e <br /> No. of compartments.......fir"- ----•...----Size ~ xri`1�quid dap+h --------Capacity. Q.f <br /> Disposal Field: Distance from nearest well- --( ---..-Distance from foundation:-.,t!Q.-......_.Distance to nearest lot 1ine.ml __--___.. <br /> f , <br /> Number of fines........:...... . .. ...... ... .Length of each line--------- -...- Width of trench__1Z_11__---__-__ <br /> i Type of filter material. Depth of filter material= _-------_--Total length_-- .r`ilQ _-_-_---_-__'...._.---- <br /> Seepage Pit: Distance to nearest well----_-oe�9&42--_Distance from fn" ndation.. r/4-____-.Dista„e to nearest lot lin�O�------_- <br /> Number of pits--_-�------------Lining material-- Q ---Size: Dia meter___ ---_------Depth-..es ------------------- <br />` Cesspool: Distance from nearest well-----------------Distance from foundation---:_+,:'-_--:-_-.Lining material..,-----._-------------------------- <br /> El <br /> -._---_- _-_--_-----.--_.❑ Size: Diameter--- --------------------------------Depth-------------------------------------------------..-Liquid Capacity- --------------gals. <br /> 'P.rivy: Distance fromnearest well-------------------------------- __-----Distance from nearest buildingf-----.--.------_--.-__---__----_-.-.--- <br /> Li ❑ r Distance to nearest lot line--------------------------------- --------------------------•--•--- --------•-----------•-------------- ------------------------ <br /> ` 'iRemodeling and/or repairing (descn{je)�`i-t--�-�y �--r,-- - ------•--- -- - --- --=-=-�---------------••---------•-----........--•-------- <br /> .. i-; { f; <br /> <y 4_ I 'I I <br /> -----------------------------------------------------!­•-----•----------------....------ <br /> k <br /> ___________________________________________________________________________________________________________________________________________________•-_-.•---_-__--•-__-__-----..--_._------.-.-_.---..---. <br /> I 'hereby certify that f have prepared this application and that the work will be done in accordance with San Joaquin County <br /> i ordinances. State laws, and rules end re Mations of the San Joaquin Local Health District, t• <br /> (Signed)-------------------------------------- J -- ---- 3 --- - -- --,-------------------;----------(Ownep-mugar Contractor)- j- <br /> f . <br /> By:---------•-------- i -- • . ..........(Title)... z�%i --------- .. ------ --------- c' <br /> { (Plot plan, showing size of lot, location of system in relatio o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------p = = DATE...------ ._ rte.. ---••------------ <br /> REVIEWED BY.......... 'y-_-----i .+ ------- ----------- <br /> i------------------------------------- DATE------------------------ ----------•--•--------------- <br /> BUILDING PERM IT`ISSUED-' ----------'------------- ----------------I_ DA%TE--------_------- ---------------=---=-•---- ------•- <br /> Alta at pits nd/or recommend'ations:----------------------------------- ---------- • ! ..-.. ------------.-...-----••-----------------•-----------•-••------------•----- <br /> ' y � ---------�'...... ---------- ----------- <br /> _ _ ------------------------------- ------------------------- <br /> fk .......•-- -- - - — -- ----- ------ ----------------•-.---- ,F -: ----- - <br /> f = �2 Y-=--- ----- <br /> a <br /> FINAL INSPECTION BY.... <br /> .. ---- -- ------- -- ---- ---- --- Date....� -- - f "r -�------------- <br /> a � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT �` { <br /> tk <br /> 130 South American Street 300 West Oak SrnN 144 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br /> 4 <br /> s a <br />