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71 <br /> ------------------------------ --------- ------ APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------------------------- ------, (Complete in Duplicate) <br /> —-------------------------------------------------- - This Permit Ex fres 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 with County Ordinance No. 549. <br /> JOB ADDRESS LO RTIC ­'! <br /> C Y--- <br /> - 2 ' ) <br /> -- <br /> .----------- ------------I- <br /> ------------------------------------------------------------------------------------------------------------- <br /> Owner's Name__.__ -------------------------------------------------------------------- <br /> ------------------ Phone..-------- <br /> Address-------------- <br /> Contractor's Name. --------------------------------- <br /> --------------------------------- ------------ ------------------------I—------------------ Phone.................. <br /> Installation will serve: Residence Apartment House [] Commercial ❑El Trailer Court ❑E] Motel E] Other <br /> ❑ <br /> Number of living units: ...V. Number of bedrooms --V-. Number of baths <br /> -4... Lot size <br /> Water Supply; Public system O4�6ommunity system [I Private E] Depth TO Water Table JrL7 <br /> ft. <br /> Character of soil to a depth of 3 feet: Sand El Gravel [-] Sandy Loam [] Clay Loam E] Clay C1 Adobe M'-'H"ardpan E] <br /> Previous Application Made: (If yes,dicite--------------------) No V New Construction: Yes No E] FHA/VA: Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I. <br /> ti nk? <br /> Sep Distance from nearest well-_____-_________Distance from foundation_________----------Material <br /> Dis No. of compartments -------- Size-------------••-----------------Liquid depth------------------------Ca aci <br /> ....................... <br /> Distance from nearest ------Distance from founclation--1.41� Distance to nearest lot line___----.. <br /> 4 <br /> well- <br /> Number of linesA -l'--1.------------------Length of each line____ h. .............. <br /> Type of filter mat.eria-, --J­�---------------Width of trenc ------:Z$, -- <br /> -wa - IF------ —1 le j---------------- <br /> Seepag t: I -- --------Depth of filter material-------tr._____._Total length­-­ /0-------------------------- <br /> Distance to nearest well-.- 4f <br /> Lrf Number of its------! A---A-01-.............Distance-frQm­-foundafion--/0.............Distance to nearest lot line.-6----------- <br /> ----------Lining maferial-'--A-0-Vk-----Size- Diameter'-`I__'FDepf h-------- <br /> ---------- <br /> Cesspool: Distance from nearest well_________________Distance from fotindation----------------.Lining material <br /> El Size. Diameter------I--------------------------------Depth----------------------------------------------------Liquid Capacity----------- <br /> I ...........gals. <br /> Privy- Distance from nearest well----------------------------------------- -------Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line________________________________ <br /> Remodeling <br /> ine-- -----------------------------Remodeling and/or repairing (describe):______.____________._" ' <br /> •----•-------•--------------•----------•--------. <br /> ---------------------------------------- <br /> 11-----------------------------------------­---------------------------­--------­-----------------------------------------­--------------- ------- <br /> ----------I-------------------------------------------------------------------------------------------------------------------------...-----­--------------------------------------------- --------------- ..............- <br /> I hereby certify.that I have prepared this application apd that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the J quin Local Health District. <br /> (Signed)-......... <br /> -------------------------------------- ------------ ------------------------------------------(Owner and/or Contractor) <br /> ----I <br /> buildings,-- ---- - --- ----&/ings, efc.. can be placed on reverse side). <br /> --------------- -- ---------- -------- <br /> By:----------------............................. <br /> (Plot plan, showing size of lot, locafioni-0-i-syst'e"m in------ --i f-0--well- -----------------------------**---(Title)---------------------------- .......... ............. ......... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- ATE------------ <br /> -7---- ------- <br /> REVIEWEDBY ------------------------------------------------------- D <br /> DATE--------------------------- <br /> BUILDING PERMIT ISSUED-------------------I---------------------------------------------------------------*---------------------DATE-------- <br /> Alterations and/34 recoomendations ------- ........------------------------- ------------- ---­------------- <br /> -----------I------I------­----------- <br /> -------------------­ ........../� ----------141,------- ----- ----------------------------------------- <br /> --------------------------------------------------------- ------------- 7 <br /> ---- --- --- ---------------------------------------------------------------------------------- ------------------------------------------------ <br /> .......... ------------------------ -------------------------- --- ------- -- <br /> -- ------------ <br /> - ----- ----- ----­------------------------------------------ -------------- -------- ------------------------------------------------------------- <br /> -------------------- - ....... ----------/.1-- -- ----- -----------­:­------------------------------------------------------------------�Z-----------­------ --------------------- ----- <br /> FfNAL INSPECTION BY---- ------/...... ...I- -.t --------------- ----------------- Date------ ....... 4-­4� <br /> --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 1124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodir California Manteca,California <br /> Tracy,California <br /> ES 9 REVISED B.59 2M 5-62 ATLAS <br />