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FOR OFFICE USE: <br /> 'it No. <br /> PERMIT Perm <br /> APPLICATION FOR SANITATION ;7/ <br /> ------------------------- (Complete in Duplicate) Date Issued <br /> ----------------------I---- -----I This Permit Exl2ires 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 described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 4 .................-------------------------------------------_----------------------------- <br /> JOB ADDRESS A�Nl) LOCATIQ--------- -- ----- - .......... Phone-----•--------- -------------------- <br /> Owner's Name__..__ - --- ------- --- -v-id-------------------------------------------------------------------------- <br /> ---------- Z L---------------------------------------.................................................................. <br /> Address................... ..................----------------------------------------- <br /> --------------- Phone-----Nam�:__. -W-04— ---- I <br /> ............... ----------------------------------------------- <br /> Installation,will serve: Residence F1 Apartment House [j Commercial C@ Trailer Court [3 Motel 13' Other [j <br /> Number of living units: -------- Number of bedrooms -------- Number of baths ........ Lot size ----------------------- <br /> Water Supply: Public system jig, Community system [I Private C] Depth To Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel El Sandy Loam El Clay Loam F-1 Clay ❑ Adobe 52 Hardpan C1 <br /> Previous Application Made: jif yes,date------------ - No [I New Construction: Yes_Q No E] FHA/VA: Yes [I No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: available within.200 feet.) — <br /> (No septic tank or cesspool permitted if pu is sewer is <br /> Ic anot from foundation.-- Mater' ........1.6....... <br /> Septic Tank: Distance from nearest welL,4L----Di t --r ----------------- ;V_ <br /> "o <br /> -2 ze,-" _J_� 7r apacity-.- -00 <br /> No. of compartments-----_ ._. ........._Si ------):5--------Liquid depth--------- ----------------C <br /> 1�0 le <br /> Disposal Field: Distance from nearest wellfoundation-__ . .....Distance to nearest lot Ii <br /> sfance from foundaf ---- <br /> ---------Width of french------ ---------_--------- <br /> Number of lines--------------- ---------\---------Length of each line---- 5, , <br /> Type of filter maferial./ I ---------- <br /> - <br /> a-c-material. {----_Depth------D60th of"filter materia ------Total length <br /> Seepage Pit: Distance to nearest well------------------ -,Distance from foundation-----------........Distance to nearest lot line----------------- <br /> I ----------------Depth-------------------- ----------- <br /> Number of pits----------------------Lining------Lining material----------!-------------Size: Diameter----.------------------ <br /> i - <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material___.-____________.__._------_------- <br /> Size: Diameter--------------------------------------Depth---------- -----------------------------------------Liquid Capacity---------•-----------------9 als, <br /> El 1 4-. <br /> 'Di08nce from nearest building---------------------------------------- <br /> Privy: Distance from nearest well------ ---------- -------------------------- --- <br /> Distance to nearest lot line.----------•----------------- ---- --------------I--------•------------------------------------------------------------ <br /> 0 <br /> ----------------- --------- —----------------------------------------------- <br /> Remodeling and/or repairing (describe):---------------------------I--------------------------------- ---------- <br /> -------------------------------- ---------------------------------------------------- I--------------------------i------------------------------------------ -------------------------------------------- ----------- <br /> ------------------- <br /> -----------------------------------------I-----------------­---I----------------------------------------- --------I---_--------1­­�-----------­------------------- ------------------------------------ <br /> I . � --------I---------------------------- <br /> ------------I---------------I------------I--------­----------------------------------------------------- <br /> ----- --- the w V will lye done in accordance with San Joaquin County <br /> I hereby certify that I have prepared this application and that or <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ----------------------------------------------------------------------(Owner and/or Contractor) <br /> By:--------------------------------------------------------------------------------------------------------I-----_-------------------(Title)----------------------------------------- - -------------------- <br /> (Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc., can be placed on reverse side). <br /> FOR D-f PARTMENT USE ONLY' <br /> APPLICATION ACCEPTED BY_ ------ ----- -- ---- ---- ------ I-------- - --------------- D <br /> REVIEWEDBY--------------------------------------------_------------------- ------------- ------------------ ------s---------.. DATE--------- •----•- -- ----------------------------------- <br /> BUILDING <br /> --------------- <br /> BUILDING PERMIT ISSUED__.. ___--------- -----------­---------- DATE..-- ------ - --------------------------------------- <br /> -_------------------ --------------­-­---------- ---------- <br /> Alterations and/or recommendations---------------------------- ---------•-----------_---------_ -------------- <br /> ------------------------ --•-------------------------------------------------------------------•-------------------------------------------­---------------------- - - . --------------------------------------------------------------- ------------rA--------_-_------ ----------------------------------------------------------- <br /> -----------I------------ -------------------------------- ---------------------- ------------------------------- ----------------------- ---------------------------------- <br /> -----------I---------------------------------------------- ---------------- ------------------------------ <br /> ----------­...........I.................. ---- ------------ --------------- ------------------------ ------------------------------------------------ -------------------- <br /> FINAL INSPECTION 8 --- I---- -- <br /> SAN JOAQ N LOCA . ALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Well 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-59 2M 5-62 ATLAS <br />