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t-UKUt-l-K-L USE: <br />------------------------- ---------------------------- <br /> ------------------------ <br /> ----------------------- APPLICATION F0'9 SANITATION PERMIT Permit No. <br />------------------------ ------------------------ (Complete in Duplicate) Date <br /> This Permit Expires I Year From Date Issued Issued ..... <br /> Application is hereby made tc the San Joaquin Local Health <br /> r District for a permit to constr 'install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION. <br /> V_ -------- <br /> _-W.t.........4 <br /> Owner's Name------.....6�01 "---------1--------- ------------------------------------------------------------------------------------ Phone------------------------------------ <br /> Addr6s's---- 4------ <br /> ."It, - ------------- ---------------------------------I................................ <br /> 'e.,0 'o, - <br /> Contractor's Name...-..., .�. <br /> ------------------------------------------------------r......M�--------------_--­- ......... Phone............................. <br /> Insfallafion will serve: Residence M Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other <br /> Number of living units: -1 Number of bedrooms ---;_L__ Number of baths Lot size _�lln?-- '-el. +.__l;._4_________________ <br /> Water Supply: Public system [] Community system [] Private JR Depth to Wafer Table _�_a ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [j Sandy Loam JE Clay Loam;K Clay E] Adobe 0 Hardpan M <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes E] No [] FHA/VA: Yes E)- No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ------------- <br /> S,tpfic Tank: Distance from nearest well---— Distanlc�,�ro .foundation----IA.'_......Material------------- --e-&� <br /> No. of compartments-------4.-L.............Si <br /> 'Ze ---Liquid depth-----_. ----------capacity._/.A,C� <br /> . <br /> Disposal Field: Distance from nearest Distance from foundafion....IR Dis'fance to nearest lot line .0....... <br /> Number of lines--------fri, -4----------------Length of eac' � line'------/_X$--------------Wi�lfh of french.....A� _V--`----------------- <br /> Type of filter maof filter er material---- e--l -------.Total length----J_P7P---------------------- <br /> _4 , <br /> Seepage Pit: Distance to nearest --------Dista'incerf7om f undafion--ZP........-.Di t nce to nearest lot line---!;�7--------- <br /> ,rrw .Size: Diameter----1. ......... Depth__. R;. <br /> Number of --------------Lining material.. ------ F. <br /> ......................... <br /> Cesspool: Distance from nearest well-----------------Distance,from foundation.___---.-----_----Lining material-----_-------------------- ------ <br /> ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity--------------------------gals. <br /> Privy: Distance from nearest well-------------------------------- ---------------Distance from nearest building_______________.____._________________.._. _ <br /> ❑ <br /> uilding------------------------------------------ <br /> 0 Distance to nearest lot line- ------------------------------------------ <br /> Remodeling and/or repairing (describe):------------------------------------------ <br /> -----------------------------------------------------------------------------------•---•---._...- <br /> y <br /> ------------------ <br /> ---,------*------------------------------------------*------------------------- ------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ---------­-------­------------------------- --------------------------------------­­-------------- <br /> ---------------- -­--------------------I------ --------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared thris application and that the work will be done in accordance with San Joaquin Cou <br /> ordinances, Stat aws, and, rules andrealions of the San Joaquin Local Health District. <br /> . . .................. ... <br /> (Signed) ------------------------------------------------------------------(Owner and/or Contractor) <br /> By:.--------------------_................ --------------- --------------------- <br /> ----------------------------------------------------------------------------------------(Title) - <br /> (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 1� FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------------------------------------------- DATE------ '. �" <br /> REVIEWED <br /> ATE------ <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-----------------_--_---- <br /> BUILDING PERMIT ISSUED----------------------------------------__------------------—-------_--------------------_..... DATE <br /> Alterations and/or recommendations:------------------------------------------------------------ ....... ------------------------------------ <br /> -----------­......I----------- ------------------------------------------------------------------------------------- ------------------------------------I....... ---------------------------------------­----------- <br /> . ........... ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- --------------------------- <br /> ---­------------------------ ------------------------I--------------------------------------------------------------------------------------------------------------------------- -•-•----------------------...------------- <br /> ----------- <br /> ­------------------------ ------------- <br /> ------------;-------___----------------------------------------------------------------------------------1--------I---------------------------------------------------------------------------------------I--------------- <br /> FINAL INSPECTION BY:---- <br /> ------------ <br /> --------------------- ------------- ------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 IM 5-61 ATLAS <br /> % <br />