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1 <br /> FOR OFFICE USE: <br /> ------------- APPLICATION FOR SANITATION PERMIT Permit No. _ a <br /> ..... .............................I.........I----------- <br /> ........ -------------------------------------- ........ (Complete in Duplicate)i /Z / <br /> ............................................______.__.. This Permit Expires ViYear, From Date Issued <br /> Data Issued ......J......./.6 L� <br /> Application is hereby made to the San Joaquin Local Heal}h-District`for,a permit to construct and install the work herein described. <br /> This application_'is made in compliance with County Ordinance No. 549. V 03 - /3 a -CLI <br /> JOB ADDRESS AN LOCATION__ <br /> t <br /> Owner's Name. . ------ .._. r.4 �-..--------------- - --------------------------------------- ---------- Phone--------------------­--------- <br /> S n r <br /> Address. r <br /> Contractor's Name............ ....... .................................... Phone.............. -••-•-------} I <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel (] Other [I ' J <br /> Number of living units: __/._. Number of bedrooms-. _. Number f baths __ Lot size .... . _ __ _ � _....___._._- <br /> Water Supply: Public system ElCommunity system ❑ Private Depth To Water Table ........ it. <br /> ��Character of soil to a depth of 3 feet: Sand El Gravel El Sandy Loam E] 'Clay Loam ❑ Clay[:] Adobe❑ Hardpan <br /> f Previous Application Made: (if yes,date-------.............) No ❑ S"New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> IV TYPE OF INSTALLATION AND SPECIFICATIONS: -: -7 m <br /> (No septic tank or cesspool per-mitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.................Distance from foundation....................Material......................................... <br /> .____..._ <br /> ❑ No. of compartments...-......................Size............................:...Liquid depth..........................Capacity----------------------- V <br /> Disposal Field: Distance from nearest well.-____.___..-_--Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of lines...:...............................Length of each line_.!..,---.--------------------Width of trench._._.:_.....---...--•--------....-- <br /> Type of filter material-_----------------------Depth of Pilfer material-----------------------Total length..............................:-_._--•--- <br /> Seepgb/Pit: Distance to nearest well___-1.A9---------Distance from 'e to nearest lot line----------------- <br /> Number of pits_________I-----------Lining material. -F- ..._Size: Diameter__._...?1.-.-__-..,Depth_- ---­----------- <br /> Cesspool: Distance from nearest well.................Distance from foundation--------------------- material--------------,...................... <br /> ❑ Size: Diameter---------------------------------------Depth..........................•-------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well................................................Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------- ..................-•------....----------------•-•--------------------- F- <br /> Remodelingand/or repairing (describe):.....................................................------------------------......................--------------------------------I.._................... " <br /> ..................•••••------------............................-----•.._..__...-----------------.........-•--. ----------------•--- ................._..-------- <br /> I hereby certify 0an <br /> have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State lawrules and regulations of the San Joaquin Local Health District. p <br /> i (Signed................ ...•-••-•-•-........_..._.._....- f?, <br /> -------..__..................--------------------.............._........--,(Dwner and/or Contractor) <br /> BY:_...----•... .. +-l/ >4 • .........:--.----..................................(rtle)-------------------•--••---.....----......--.---..-•--.----.-- <br /> (Plot plan, showing sae of lot, location in elation to wells, buildings, etc., can be placed on reverse side). (A <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--- ...... ..................................................... ---- DATE...i = ............................................... <br /> REVIEWEDBY.........-•---------------------------------------------------------------..--------- '•------------------------------------- DATE----.--.._.---.---_.__..-_--------------------------------- <br /> $UILDING PERMIT ISSUED '---------------------••-•----•--------------------------...............------------ DATE------------------------------------------------------------- <br /> Alteraflonsand/or recommendations:. ...................... -------------------------------------------------------,--------------------------------------------------------•--------.--------- <br /> r , <br /> i <br /> ..........I——................................:......--------...................... ................-._............................................--------------•-•----..._.....................I.......................... <br /> ..........................................................................--------------------------------------------------------------- <br /> I <br /> ... <br /> FINAL INSPECTION BY:.. ..,.--�- ,. -_._..... -• =f` Date e .-._�....,. '> y <br /> ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT f <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street I <br /> Slocklon,California L",Callfamia Manteca,California Tracy,Colifomin <br /> ES 9 REVISED 9.59 2M 5•$Z ATLAS - <br />