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rUK Urrll-C UJt: <br /> ---------------------------------------- ------ <br /> -'-------------------------------------------------. AITUCATION FOR SANITATION PERM T Permit No. _..•----./----.-- '__ <br /> ------- -- ------------------------ ----------- (Complete in Duplicate) 1 <br /> -------------------------- ----------------. -. This Permit Expires 1 YE ir From Date Issued <br /> 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 with County Ordinance No. 549. 1144/v x`33 NFXT Tp THr <br /> JOB ADDRESS AND LOCATION_. 30X__.7`l-SY.-----Z�'/fC'v-----------------------C'91e8Q41A_...a{ .�1,----1f�rtrPT_/1__S10 -'---------- <br /> Owner's Name 'C'n'Q f/41 ------------------------------------ ------------------------•----__-----------... - - Phone_7-47Ss�_f®�-------•-- <br /> Address-----------------4-P20------�©u_ wFw <br /> Contractor's Name------ ------------------------------------------ Phone_,'.A 4f5;1-%r----- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---I... Number of bedrooms _.3__ Number of baths z-__ Lot size ------ ------!fevE ____________________ <br /> Water Supply: Public system ❑ Community system ❑ Private [•Depth To Water Table _30_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam n- Clay Loam [Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No [ New Construction: Yes B`­No ❑ FHA/VA: Yes ❑ No [� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-ff-0_'_____.Distance from <br /> � fou_ndation-----l0.........M! rial----- C ��/C�_._ <br /> ® No. of compartments__--... --------Liquid depth---- G.----Capacity./Ar'-ple---...._.-_- <br /> - <br /> Disposal Field: Distance from nearest well__t,3Ti?'____Distance from founAation_-_ _'..___.Distance to nearest lot line_-_- <br /> ® Number of lines------------,..3------------------Length of each line'=_` :_.✓_ idth of trench--___�S_.4-�___----------- <br /> Type of filter material-------/>O('!tk.---Depth of filter material-------- -Total length_____________ __S�c�_.'-------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 1-1 Number of pits____________________Lining material----------------------- 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:-----_. ------- ----------------------------------------------------------------- <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 of the San Joaquin Local Health District. <br /> (Signed)----------- =/--.�--- -------- ,-- ------ -•----------- (Owner end/or Contractor) <br /> By:-------------------•/-- r;� = ---------------------------------------------(Title)------- r----------- --- - <br /> (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- --------------- -----------------—----------------­------­-._ DATE----------------------------------------------------------- <br /> REVIEWEDBY------ ------ -------------------------------------------------------- f - DATE-------1- ,!'e ._..x------------------------ <br /> ----------------- ---------_---_-------- <br /> BUILDING PERMIT ISSUED-------------------------------------- DATE <br /> --------------------------- ---------------------- <br /> Alterations and/or recommendations:-,------------------------------------------- ....... -------------------------•--••-------------••-----------------•---•-•-••--•------------------------------ <br /> - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -•------------------------------------------- <br /> ----------------------------------•-----------------------------------•-------------------------------------------------•----------------•------- --------------------------------•-- ------------------------------------- <br /> .....--•-------------•-------.---------------------------.-------------------------------.----------------------------------------•---•-----.---------.--•.----------------------------------------------------------- <br /> ----------------------------- --------------- -------•----- ------------------------------------------------------------------------------------------•-------------••-----------------------•------------•--- <br /> FINAL INSPECTION BY:.------- ------------- ------ - ------ Date------- -------/------------------------------------------------ <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 8-59 2M 5-62 ATLAS <br />