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rVKUt-1­11L�t U,) <br /> ---------- ------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------- --------------------------------------- (Complete in Duplicate) <br /> ------ -------------------- ------------------------ 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 describe.d. <br /> This application is made in compliance with County Ordinance No. 549 <br /> e:57— 2-90-1 <br /> JOB ADDRESS AND <br /> LOCATION <br /> N- e <br /> .I.... <br /> 0wrer's Name--------- ? &; .... <br /> ---------------------------------------------------------------------------------------- Phone................................... <br /> Address- <br /> - <br /> ------­-------------------•--•--------------------•-----•--•-------------. <br /> -----*-*,*-------------------------*----------**-­--------------- ---•--•-•--•-----------------------•- <br /> .....*------------------------------ <br /> Contractor's Name------------- ------------------------------------------------------------------------------ Phone..------------ <br /> .Installation will serve: Residence [Apartment House 0 Commercial El Trailer Court E]. Motel [] Other' o <br /> Number of living units: ___I._ Number of bedrooms &-- Number of baths Lot size 11.11'41F;]eK,_-0!�:------------------------------------ 4 <br /> 7. <br /> Water Supply: Public system [-] Community system El Private ��Depth To Water Table AA ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel 0 Sandy 411 L -am <br /> o -B--aay-Loam [] Clay 0 Adobe @--Hardpan <br /> Previous Application Made: (if yes,date___________________} No P9, Nev; Construction: YesN <br /> RNo E] FHA/VA: Yes Z?---No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 <br /> feet.) <br /> Distance from foundation---- lvia <br /> Septic Tank: Distance from nearest wel --- ------- _. terial--- <br /> ---------------irkz.......... <br /> UV" No. of compartments-___ ------------- .......... <br /> Ye.!Liquid dep�h.... ---------------Capacity_/X ...... <br /> Disposal Field: Distance from nearest welL/ ....Distance from foundafion--/P...------- line <br /> Distanc\e to nearest lot lin _j:--------- <br /> Number of lines---- .-Length of each line___Ar�. -.Width of'french---;!P- <br /> Type of filter material./4�.�---------- _;�- --------------------- <br /> ---Depth of filter mateirial----;T'------.---Total length_.,_/dV <br /> Seepage Pit: Distance to nearest well---Aw/....Distance frgm foundation___. .---.Distvce to nearest lot line--- /------ <br /> 113;1" Number of pits_______---.______------------Lining materiaI___ Xt?A_____.Size: Diameter---1?j--- ---------Depth---- ___-_-_ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material------------------------------------- <br /> Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity- ------.gals. <br /> 1.Privy: Distance from nearest well----------------------------------------- -------Distance <br /> -,from nearesf,&ilding---------------------------------- <br /> - - <br /> Distance to nearest lot line_______________________________---_-______.___._----------------- <br /> ---A-.-;zn--------------------------------------------------------------- <br /> �Remocleling and/or repa.iring (describe):---------- -------------------------------------------------------- <br /> ------------------------------------------------------------_------------------------------------------------­-------------------- -, ----------------------------------------------------- <br /> ------------------------------------------------------------------ ---------------------------------------------------------------------- ---------------- -------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------*----------------------•---••-••------'------•••••-•---------------------------- <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, nd rules and regulations of the San 3t4quin Local Health District. <br /> 'u-nty- <br /> .(Signed)----- cf <br /> ............. <br /> ---------;a --------- <br /> 4 , -_ --- ' - ------------ - ---------------- ---------------------------------(Gbw��or Contract <br /> By:------------------------------------------------------- <br /> ------------ <br /> ------------ Title. <br /> -------------- ----------------- <br /> (Plot plan, showing size Wliot, iloatiio�,of�--s'_y's+; in relation to wells, buildings, etc., can be placed on reverse side). <br /> _!"f <br /> FOR <br /> DEPARTMENT USE ONLY <br /> PTE <br /> APPLICATION ACCE_"D BY-------- ----------- DATE-------- -- <br /> REVIEWED BY----:��------------------------------- - __E------------------------------------------------------- <br /> ------------------------ ------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------------- DATE-------- <br /> Alterations and/or recommenctafions:-.67, -- - ----------- ............ ------------------ <br /> 7----- ------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------­J:�----------------- <br /> ----------------------------------- ......./ ­ <br /> ------------------------------------------------------------------------------------------------------------------------ ---------------------_------------------------- <br /> ..................... -------------­------- ---------------------------------------------------------------------------------------------------I----------------------------------------------------------------------- <br /> ................. -------------------------- -----------------­----- - - - --------------------------------- ----------------- -------------------------------------------------------- <br /> ----:------------------------------ <br /> FINAL INSPECTION BY....'�T; <br /> Date------ ---------------------------- <br /> SAN JOA IN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak StreiltSvcCsMo treat, 205 West 9th Street <br /> Stockton,California Lodi,California N 1�t , ,re� <br /> Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />