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FOR OFFICf USE: -,Te <br /> - -------- ------- �kl AT FOR SANITATION PERMIT <br /> -------- ----- / <br /> A Permit No. <br /> ---------------------------------------------------------- (Complete in Duplicate) Date Issued /zvl�/ <br /> ----------------------------------- .......... This Permit Expires I 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 /> JOBADDRESS AN LOCAT ON...... .............................................................................................................. <br /> Owner's Name--•- ., _. , �4' <br /> e.9----- - ------ --------------------------------------------- Phone.................................... <br /> Address.......1-32.2.... ......... <br /> I I - -----------Z,--------------------------*----------------------------------------*---------------- -------------------------------- <br /> Contractor's Name.--...... .................. e ............................................................................. Phone................................... <br /> Installation will serve: Residence ,Apartment House E] Commercial [] Trailer Court 0 Motel 0 Other 0 <br /> Number of living units: -._1.._ Number of bedrooms --_J__- Number of baths A... Lot size .../0PP X.X_A 0............................... <br /> Water Supply: Public system E] Community system [I Private [!rDepth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand (:] Gravel 0 Sandy Loam 0 Clay Loam [] Clay [-] Adobe 0 Hardpan 0 <br /> Previous Application Made: (If yes,date--------------------) No ®-- New Construction: Yes [jji o [] FHA/VA: Yes 0 No F ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 4r <br /> Sept.' T nk: Distance from nearest well.__._--.-Distance from foundation.kig....._......Material....__ <br /> No. of compartments....... (. .....Size........2.-X.4 ---Liquid depth---=_I�----------------Capacity..... <br /> Disposal Field: Distance from nearest well-1.0.........Distance from foundation...........4a *...f <br /> .....Distance to nearest lot line&f7.......... <br /> Number of lines..... Length of each line...... _0................Width of trench..__.... <br /> .......... ------------- <br /> Type of filter material._-_A----ef-------Depth of filter material.—It.0----------Total length......e-4�-I........................... <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 /> 0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well________________________________________________Distance from nearest building___............_......_.............._.... <br /> 171 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------I............................... <br /> Remodelingand/or repairing (describe):-----------------------...........................................................................................I.................................... <br /> ........................................................................................................................................................................................................................... <br /> ............................................................................................................................................................................................................................. <br /> .......................................-------------------I--------------------.............................................................................. ----------o---------------------------------- <br /> ----------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance-,vA*,San Jo"uin County <br /> ordinances, State laws, and r s an regulations of the San Joaquin Local Health District. <br /> (Sighed).. . a-_-------------------- --------------------------------------------------- ....................................(Owner and/or Contractor) <br /> .... ....... ..... i <br /> By:...--•------------ ........ ..... ................-----------..........................................................(rifle)................................................................ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY...J J ------------------------------------------------------------------------ DATE...Z(j.—Z� .................... <br /> REVIEWED BY.................................... ....... <br /> ------------------------------------------------------------------------------- DATE----------------------*---------*------------ ....... <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------....................................... DATE............................................................. <br /> Alterations and/or recorhmendations:--------------------------------....................................................................................................................... <br /> ............................................................................. ----------------------------------------------------------..................................................................................... <br /> ............................................................................................................................................................................................................................ <br /> ............................................................................................................................................................................................................................. <br /> ............................... .......... ------------------­---------- ................................................................................................................................................. <br /> FINAL INSPECTION BY:..'_I& Date----- <br /> --------------------------------------------- ...................................... <br /> V SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodl,California Manteca,California Tracy,California <br /> ES 9 REVISED 6.59 RM 5-61 At IAS <br />