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FOR OFFICE USE: <br />----------------------------- --------------- ----------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ... ........--------- <br />------------------------ ----------- -------------- (Complete in Duplicate) <br /> ------- -- <br /> --- --------- ------------------------r--- This Permit Expires 1 Year From Date Issued 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 LOC TION..------ ....... -------- _-------_------------------------- <br /> ----------------------------------------- <br /> Owner's Name------------ ..............%PZ <br /> ........... . <br /> Address ---- -------------- � <br /> ------ .... ------------ ------------------------------_----------- <br /> Contractor's Name--------------------------------------- -------------------------------------•-----•---•-----•--------•-------• Phone_............... <br /> Installation will serve: Residence [] Apartment H10"Use [] Commercial E] Trailer Court El Motel 0 Other R <br /> Number of living units- -------- Number of bedrooms -------- Number of baths -------- Lot size ......... <br /> l!.4.q_.;a--------------- <br /> Water Supply: Public system 0 Community system El Private [] Depth To Water Table 2,A-ft. Adobe L] Hardpan C] <br /> Character of soil to a depth of ffeet: Sand C] Gravel C] Sandy Loam C1 Clay Loam [Z Clay [] <br /> Previous Application Made: (if yes,date----------- --- ---) No U New Construction: Yes [:1 No [2 FHA/VA: Yes El No 54 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ------------ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well------%r—.g>--Distance from foundation...... f-------Maferia <br /> No. of compartments---------2---------------Size-----�V. vej Capacity......-_" <br /> ------Liquid dep:fh---------- C <br /> -7----------- <br /> Disposal Field: Distance/from nearest Distance from foundation------2—. -o.....Distance to nearest lot line..------e_®. <br /> JRNumber of lines---------------Z------- ----Length of each line------- ------Width of trench.____._.-___-11=n-------------- <br /> Type of filter material...g&rc,_-rL_Depth of filter material_.____..* r-..._.__Total.....Total. length...............0--or------------------ <br /> Seepage Pit: Distance to nearest well___­!_�7--------------Distance from foundation--------------------Distance to nearest lot line_-------------- <br /> El Number of pits---------.-;! ----Lining material---------------------- Size: Diameter-.---------------------Depth-----------------_------------- <br /> ..xr17 1') <br /> Cesspool: Distance from nearest well-----------------Distance from!foundation------------------Lining material------------------------------------- <br /> ❑ *1 1� Liquid Capacity---------------------------gals. <br /> Size: Diameter.e----------------------------------Depth-------------------------------- ---------- <br /> _Disf�nce from nearest building----------- ---------------- <br /> Privy: Distance from nearest-well---------------------------------1------- x <br /> Distanceto nearest lotAine------------------------------t—------------------------------------I---------­----------------------------------- <br /> 11 1 <br /> ................. <br /> ------------------- ...................... _e <br /> Remodeling and/or repairing <br /> pairing (clescriL):-------- <br /> ---------- <br /> .................... ----—------------- ---- *;- ------ <br /> —------------- <br /> -------------/X-------------- ----------,--------------------------------------------------------------- <br /> -------------------------------- 4W <br /> It ....... .0. - ------- ----------- ------------------- ------------- <br /> ----------------------------- <br /> ............._- -------------- --------- <br /> - -------- -- -- ---------- --- <br /> -------"•---------'--- --I hereb y certify fy-_that- - I_.have prepared- -.-_this application and that the work will lbefdone in accordance with San Joaquin County <br /> oirdinances, Sfa e laws, and rules and rer- 31ptions of the San Joaquin Local Health 7 District. <br /> .0 <br /> -----------------------(Owner and/or Contractor) <br /> (Signed -- --- ---.......— ------------------------------------ <br /> BY:---------------- ------------------------------------------------------------------------------------------------:­---------(Title)---------------------------------------..._..- ------- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, itc., can be'placed on reverse side). <br /> R. DEPARTMENT USE ONLY;—. <br /> APPLICATION ACC ------------------------------ DATE-------------- G..�---------- <br /> -=----BY_ ........::� <br /> REVIEWEDBY-------------1W----_ ----0_.60--------=----=- -------=------ ------ ---------------------------------- ------- DATE--------------------------------...... ------- <br /> BUILDING,PERMIT ISSUED-----_---------------- DATE------------.... <br /> - -------- ----- <br /> Alteraf:ns, and/o recommencrati s:____ ------------- --------- <br /> -------------- <br /> ----------­­-------- <br /> ---------------- -------- - - --- --------- --------------------- <br /> ----------- <br /> Date_ ---31-- - <br /> - <br /> ---------- <br /> FINAL INSPECTION BY:.........4­61----------------------- ------ <br /> SAN J04UIN-LOCAL HEALTH DISTRICT <br /> 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,Collfornict Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />