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FOR OFFICE USE: <br />---------- ---------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..Jf.. . <br /> (Complete in Duplicate) -zi <br />--------------------------------------------------------- This Permit Expires 1 Year From Date Issued , Date Issued -.-•.. <br /> ............... <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. E <br /> JOB ADDRESS AND LOCATION__ aA -�1 -�*� <br /> !T <br /> .... 1,��........... ...... . <br /> Owner's Name._.A... y ---------- ----•--•-----•----- <br /> I " r , <br /> m <br /> / Phone------..*--------..•---••--••-•-• <br /> Address-•....Lr - ----- u LIE----------- ------- - ------ <br /> , <br /> 1 <br /> Contractor's Name....... . .... ....... 4...... . Phone-••--••---•----••-••... <br /> Installation will serve: Residence Apartment House ❑ ,Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --A-- Number of bedrooms -5--. Number f baths . Lot size ---.-- .--__-_---t.......... <br /> --- - -- ------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth t Water Table ..------ ft. <br /> Character of soil to a depth of 3 feet: Sand C] Gravel E] Sandy Loam Depth <br /> Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous A iication Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> PP �, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest welt+..Distance from foundation:-- _-.Material------------------------------------------------ <br /> ❑ No. of compartments.•• .........--...........Size............................ Liquid depth--------------------------Capacity-------• ...... <br /> - A f <br /> Dispose geld: Distance from nearest well.YSA-.-� �....Distance from foundation-----U---__._._-Distance to nearest lot line---:45�........ <br /> Number of lines--------_1----------- - Length of each line--------f.:G--'-_-----_--.Width of trench......Z,.�--------------------- <br /> Type of filter material._.. L_ _-.---Depth of filter material------1s-«--_---Total length.......4_Q-------- <br /> ................... <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits--------------------_Lining material-----------------------Size: Diameter-----------..--.-----. Depth---------------------------.-..._ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------.Lining material.------------------------------------ <br /> Size: <br /> -------------- _----_--__--.--Size: Diameter--------------------------------------Depth--- ------------------------------------------------Liquid Capacity............................gals.r{ <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building........................................... j <br /> ❑ Distance to nearest lot line----------••---------------------------------------------------------------------------••----..•----....------------------------------------ <br /> r repairing {describe):------- G - <br /> --•---•---••----- •----------------------------------------•-----••-------------------------•-----•--------•-----------------•--••---------...--------------------------------------------......------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County'.. .F <br /> ordinances, State'laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)_ "`_ .r{Ehrm pnd/or Contractor) <br /> BY= Zcaflon <br /> -•--------- ----•---------------------------------------------------------------Ariitle)--------------------------•---------... --- ------------- <br /> (Plot plan, showing size of lot, of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED 9Y--------------------------------------------------------- ---•-----------••--•-------------------- DATE-------- -•---••--------------•----•----•------•----------- <br /> REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------.... DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-------------------- --------------------------------------------------------------•-------...------....----....--------........------------------------------- <br /> -------•-------------------------------------------------- ---•------------------•---------------------------------.....-•-------.....-•-------------------------------- ----------- --------------------------------------- <br /> -------------- <br /> ---------------------------------------- ----------------------------- -------------------------------------------------------- ------•---------------------------------------•--••-•------...-----------..-..--•-•------•---- <br /> FINAL INSPECTION ----------------------------------- Date------ `---b'-- --•- ------------------------------------ <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 /> [6 0 REVISED 6.59 9M 6-4[ ATLAS <br />