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----------------------------------------------------- <br /> ------ ----------- ---- <br /> ---------.._-_--__---------- ---- --------- _ICATION FOR SANITATION PEF T Permit No. ....i. J. .....1 <br /> ------------------ -- --------- - - ----- (Complete in Duplicate) - <br /> -- -----------------------------------.---------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued ._-.-__._..'­__­'_._1- <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,tithh County Ordinance No. 549. ,0 � �{ <br /> JOB ADDRESS AND LOCATION ._ __ . _ - ' L I✓ c <br /> Owner's Name.. ��--� --------------- Phone................................ <br /> Address- -------- <br /> - - Phone...............Contractor's Name............. .....- - <br /> Installation will serve: Residence E] Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/---- Number of bedrooms __ Number of baths ­_4--Lot size ................. <br /> Water Supply: Public system ❑ Community system ❑ Private) Depth to Water Table 4141-ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay t� Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date .. . ) No�Z New Construction: Yes Ld' No ❑ FHA/VA: Yes ❑ No'n <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> — <br /> S-ptic Tank: Distance from nearest well-)12-0....Distan e from fount ation-.,_:2,_:2>._-__Material--- -+1� <` c'�-..• ..:... <br /> 0 No. of compartments.. �.............Size. _K�Q_y`-_-;-----.Liquid depth------ -_,lam Capacify_l.�;.60.... <br /> Disposal Field- (stance from nearest well--��Q-__._Distance from founds ion..,Z.�_....Distance to nearest t I}•�j�............... <br /> ��)i nber of lines__ -3_ . _Length of each line__.'./Q� r. f7�/Vidth of trench-__ fit------ ----------- <br /> ''_.__.Total length-., . ._�..., <br /> Type of filter materlal_.fl`2.�..} Depth of filter material__ 1 .. _ g _ . <br /> Seepage Pit: Distance to nearest well......................Distance from foundation_-____-.-__•----_-_.Distance to neareefla ne---__.-.-.__. <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--------------k---------------------------•-------------------------------------------------..........:---------- ................ <br /> -¢ <br /> Remodeling and/or repairing (describe):-- �'�-f` .......z► �: <br /> ------••--•----•-•-------------------------•----------•-----------•------------ -----------•----••-•----•---------------•--------- <br /> -----------•-------------•---•••-----•------••----------- <br /> ...-----•--...----•-------. m <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 of the San Joaquin Local Health District. <br /> (Signed) ......�f`--------------} - ----.....- ---- - --- --------------------- ------•------_---------.(Owner and/or Contractor) <br /> By:------------------ ------------------------------------------------------- ------------------- ----------------------- ------------(riifle)---------------- ---------- - - ---- - . <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.............. ---- DATE....-_.-___ <br /> r <br /> REVIEWED BY------------------------------------------------------- -_.. �- - DATE..----- C`� = -------------- <br /> BUILDING PERMIT ISSUED.................................................. DATE............................................................. <br /> Alterations and/or recommendations:.............................. •---------------------•--•---------------------•----------•--•---•--------------•---•-•----------•-•-•----- <br /> ---------------•---------------•---•------------••.........--------•-.......-------•----------•--••-------••---••--•--•------•-----••-••••---•------. . . . . ----------------••-----•--.._..---------•------...------..-_._.. <br /> -------------------------•---------•--•--------•--------------•--------------------••-----••--•------------•-------••--------•-------------------- -----.. .............................. .................................. <br /> ......................................... ....•-----•••--------•-------•-------------------------•---------•--•------•----------------------•---••--•-----•-----•--•------................................................... <br /> ....................................................................`-• . --••- •-------------•---•----------•-•---•--............ ------ ---- -- ------------••----------.._...--•--..__...----•-----•----------.......... <br /> FINAL INSPECTION BY:... ------- Dete- ---- /�.'.-C� •------------------------ <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,California <br /> ES 9 REVISED e-59 2M 5-61 ATLAS <br />