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FOR OFFICE USE: <br /> ..----•-....... -=------•-••---••--- - ------ ---- <br /> .......... .............................................. APPLICATION FOR SANITATION PERMIT Permit No. . <br /> (Complete in Duplicate) <br /> Date Issued <br /> _--------------- _-_-.__.._---_-----.-.._.__.___ This Permit Expires 1 Year From Date Issued <br /> ----_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct a d install the work herein described. <br /> This applicationis-made..in_complience with County Ordinance No. 549. r <br /> JOB ADDRESS AND LOCATION_ „________ ____________„x . f D Q3,_-__,_,- <br /> Owner's Name ff'r - ................. ................ Ph <br /> one <br /> Address lrfl:._.! 1 ! �e ---------•-----_ ••- - <br /> Contractor's Name...... . efC_.e. <br /> --1(l• hon --•-...._...•--........ <br /> Installation will serve: Residence Apartment House Commercial Trailer Court <br /> ❑ p ❑ ❑ Q Motel ❑ Other ❑ <br /> Number of living units: 4_.._ Number of bedrooms ..dz.__..'Number of baths ..a2n. Lot size ........... .....�_.. ..........____.._.........__.__.. <br /> Water Supply. Public system ❑ Community system C] Private, Depth to Wafer Table�4r�ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel Q Sandy Loam M Clay LoamA Clay [❑ Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date....................) No 2) New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ;­(Na sap+ic +arik or cesspool pe`rmiffed if pub7tc sewer is availabl within 200 feet.) <br /> Septic Tank: Distance from nearest well_.._iF:�_.__Distance from foundation-1.0..........Material.. ..... <br /> f No. of compartments....o2.............. -� -f--s5 ----_...Liquid depth...... Capacity_ --------- <br /> Size <br /> D' al Field: Distance from nearest well_X"!Q'_.--.._.Distance from foundation-----t!a ...._..Distance to nearest lot line_S�f... <br /> Number of lines..._r .........................Length of each line-----/__ .q._...___.____.Width of trench.....i 'f <br /> Type of filter materia/ *-A-P-4--Depth of filter material1.. .-C �' Total <br /> length ...........--- -------' <br /> Seepage Pit: Distance to nearest well......................Distance from foundation-...._.-....._..._:.Distance to nearest lot line................_ I <br /> Numbdr of pits----------------------Lining material.......................Size: Diameter....- ..-.._------Dept h...............--•.-_._ <br /> Cesspool• Distance from nearest well-----------------Distance from foundation___._-._.__.--......Lining material-_.-_....___...__ _______..__._ <br /> Size: Diameter--------------------------------------Depth.--••----•----•------ ----•-------------•--- Li' uid Capacity ____.. gals! <br /> Privy: Distance from nearest well_________________--------------------------------Distance from nearest buildingk <br /> --•-- <br /> ❑ Distance to nearest lot line------------------------------------------------ j <br /> Remodeling and/or repairing (describe):...................................... = i <br /> -- --•---------•-•----•---_.._. <br /> ....------•---•-----•--- - <br /> ----------.---------------------------------------__--•--------•-_---•----•---------- ------•••----•-......---••-••....__.-•-•-----•-••--•-•--•-•-•------•--•--•---_._.. ------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count!•,= , <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -' <br /> � <br /> ---- ------ <br /> (Signed)�g z _ t -_-(Owner and/ Cantracfor <br /> -- -----"- {Title)--••------------------ --- -'r__.. <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............ _ <br /> REVIEWEDBY........... -------------------............................... -+a sem' <br /> BUILDING PERMIT ISSUED.............: DATE.......... ...................................... <br /> .-•--••-•-•••--••-••-••- <br /> Alterations and/or recommendations: DATE...........................•:_---___,_-„_--- <br /> ..... -------------------------------- -----------------------------------------­­------------------------- <br /> -------------------­­---­------- --------_--------- ... <br /> FINAL <br /> --••------- - <br /> FINAL INSPECTION BY:-_ <br /> r13�f--------------------- Date.... <br /> ..------•-••-•---•.................•--------••-------••-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street <br /> T 24 Sycamore Street <br /> Stockto' Manteca,California n,California Lodi,California 205 West 9th Street <br /> CS 9 REVISED a-b9 3N 3-'63 F.P.CO. Tracy,California <br /> J <br />