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---------------------------------------------- A :1CAT10N FOR SANITATION P>:R Permit No. .../_ , <br /> ------------------------------------------------------ (Complete in Duplicate) 3�C <br /> ________________ ------ This Permit Expires 1 Year From Date Issued 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 w" County Ordinance No. S49. <br /> JOB ADDRESS AND LOCATION...--- � <br /> • <br /> &- ---------- <br /> i.. Owner's Name....... e"c_ .--• = -- -----•------------------ --------------------------r------ --- Pho ----------•---------•-----=------- <br /> Address ----=------ - - <br /> --- <br /> k Contractor's Name------- ._... =' 'z --------------------- Phone <br /> .................-_-_---------- <br /> Installation will serve: Residence:❑ . Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:'...... .Number of bedrooms ________ Number of baths ... _-- Lot size•------- .�G-�. 1.................:.. <br /> Water Supply: Public system n`` Community system F] Private 0 Depth t ater Table 7-0- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: Ilf yes,cfote--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> IN* septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Styptic ank: Distance from nearest well.__Z Distance from foundation---------__________.Mat�ial...__�!� ................................... <br /> [ No. of compartments p e�_:.e�- �---�--�-------Liquid depth-----'�=-----------------Capacity--47==u•-•`.'-...... <br /> Disposal Field: Distance from nearest well------------------ from foundation....................Distance to nearest lot line....... <br /> ❑ Number of lines-----------------------------------Length of each line-----------------------------Width of french------.............. <br /> ......_...-.--- <br />! Type of filter material-------------------------Depth of filter material.------..--------------Total length.................................._......_ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line___________._____ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter........................Depth---------- _._..--------.-..-..._ <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 /> ❑ Distance to nearest lot line---------=---------------------------------------------------------------••-------------------•-------•------------------------------------ <br /> Remodeling and/or repairing (describe): ----�, _$-t��- c - =__- 4 = <br /> ...........z--•---------------------------------------- <br /> -•-----•----------------•-•------•---------------------•----------------•------•---------•------------•------- --•------------ <br /> -----------••--•-------------------------------- ---------------------------------------------------------------------------------------------------------•------------------------------------ <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law ;-and rules and �Fegulalions of the an Joaquin Local Health District. <br /> q <br /> - -------- -- <br /> {Signed]------- --- - ------------ -••-- ------(Owner and/or Contractor) <br /> Ip �. ra- <br /> By:--- �----- = --------(Title)...............-.._ <br /> (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). <br /> F' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- a' �G,_e------------------------------------------ DATE.-.....? .Zq. �� ---------=--------------- <br /> REVIEWEDBY-----------------------------------------------------------------------------•------------------------------------------------ DATE------•----------------•--•--------------------------------- <br /> 1. BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------ •--------------------------------------- <br /> Alterations and/or recommendations--------------------------- ----------------------------•----------------------•--- ---------•----------------•---------------------------------=--........... <br /> •--•----•--•-••---•------------------•-••-•------•-•----------------------------------------- --------- -------------------------------•----- -------- <br /> ----- -----------------------------------------------•---------------•- <br /> - ................­­---------------------------------------------- <br /> 3 ____-__---.--------------------__-_--_________----__-•--_______ -.._--__ <br /> .........­------------------------------------------------------- <br /> ------------------------------------------------------ <br /> ____.-.____________________________.-.__-_.-________ ..___________.__-.----__-,--_-__.-_-__.____.___------_.___-________________----..____-.--..._____---____--..._.,--.--..__..-.--.--_-_..-_.__..-._______________________ <br /> d -/p <br /> FINAL INSPECTION BY:d.---` Date-,p - -•---------------------•...---------.------------------ <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;fAlfgrnia <br /> ES 9 REVISED 5-89 ZM 5-61 ATLAS '� <br />