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-.. APPL1 �TiO!�! FOR SANITATION PERMI Tw,£: ', . IMMNo. <br /> - (Complete in Duplicate) <br /> / i <br /> ---..--....-�" ` Permit xpires 1 Y <br /> ----------------------- This Pit E „Year From Date Issued Date Issued ...-w..�.'�.-.-.. <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. <br /> JOB ADDRESS AND LOCATI N......1.�r..._! R? 1) C'��,4+ <br /> - ------ ..._-.x..?�- ---r�---------------------------•----------- � �•--- ------------------------------------------------- <br /> Owner.5 Name....- -------- ---' ji--fl, --------------------------- -- ---------•--- ---------- --•------. --- Phone------------------------•------------ <br /> Address r-------------------- <br /> -------------------------------------------------...-------------------------------..----------••--------------------.-----------------*............... <br /> Contractor's Name.- .eA +� <br /> ------------------------- Phone_...------------------------------- <br /> Installation will serve: Residence [a" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1.... Number of bedrooms A. Number of baths .4.. Lot size ............................ <br /> Wafer Supply: Public system ❑ Community system ❑ Private Depth to Water Table _,,KPft. <br /> r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [Z�- Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-----------.--------I No 91__,_New Construction: Yes o ❑ FHA/VA: Yes ❑ No R4—' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest wellh)a.........Distance from foundationl47-------------Material. -------------- <br /> No. of compartments.---2-------____-.._Size..- r/.----Liquid depth---4- ---------------Capacity./';':Y,1-.�-- <br /> t Disposal Field: Distance from nearest well_AG,�_. Distance from foundation./�?_r-...._.--.Distance to nearest lot line...`........... <br /> [►' Number of lines----r--------- ------------------Length of each line-----A.-�...---_---------.Width of french----tz_.f-'.__-.__-____-__,_.-- <br /> Type of filter material._11 ; '�... -Depth of filter material.-.4i�---__-___....._Total length_-_-_ _�________________________•---_ <br /> Seepage Pit: Distance to nearest well../uta........__-Distance from foundation-/_r...............Distance to/nearest lot line.-�- �7 <br /> �' Number of pits---�-----------------Lining matenal��'-C--�----...Size: Diameter---3�-�T-Depth-----CJ-.-.------------------ <br /> r' Cesspool: Distance fi-om nearest well.................Distance from foundation- _----___--Lining material----------------.__-----___-_------ --r' <br /> ❑ Size: Diameter----_---------------------- --------Depth----------------•.---------------------------------Liquid Capacity----------- ----------......gals. � <br /> . <br /> Privy: Distance from nearest well----------------------------------------------- .Distance from nearest building.-.... ----------------------------------- <br /> ❑ Distance to nearestlot line---------- ------------------------ -- <br /> Remodeling and/or repairing (describe)-------------------------------------------------------------------- <br /> --------••--•-------------•-••----------------- -- -----------------..-•--•------•----------------------------------------•-•----- --------------------------------------------- <br /> ••----......••-•------•-------- <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, and rules and regulations pf th San Joaquin Local Health District. <br /> f_r ----------- (Owner and/or Contractor). s <br /> (Signed)------------------- -- <br /> r <br /> BY: ---------------- _ =- ------------------- .......----------- (Title) <br /> ------------------- -- .............. <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 ONL <br /> APPLICATION ACCEPTED BY-.-.......... ....................... .- DATE-----------• --"-- --'�_-- <br /> REVIEWEDBY-------------------- ---------- --------------------------------- -- - ----------------------- ----------------- DATE------------- <br /> BUILDING PERMIT ISSUEDr . � - - <br /> . .-. _ . . -,....--.-- <br /> TE..------------- --------------•-------------- A <br /> Alterations and/or recommendations:---...-- <br /> ------------- x <br /> ------------------------------------------------- ----------- .............. ---------------------------------------- ----•--• ----------------------------­­------•--------------- ----------- <br /> ------------- --------------------•- ............°------- .. <br /> F. .................... ------------ ---- --------------------------------- -------------------- ......................... -------------I....................­......--__._1.......... ....... <br /> ------------------------------------- ---- .. .... ------ .............. ---- --------- ............. ---------- --- -------­-------- ----------------- ---r.............. <br /> -I-" <br /> FINAL INSPECTION BY:._ - Date . `-_..__�.. --- ------'----------------- - ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. , 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy, California <br /> ES 9 REVISED 9-59 3M 3-'63 F.P.Ca. <br />