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FOR O CE U E: <br /> .� ----------- <br /> - -- ------------------- -- ---------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. fP........ <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 and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOBADDRESS AND CATI N----� — ----------------------------- ;-----------------------------•----------------------------------•-------- <br /> Owner's Name------ er ------------------------- -------- ------- -------------- Phone------------------------------------ <br /> �s> d ------ - Ca ` C.-----------------------s <br /> Contractor's Name----------- ---------�v ,,� p �`�- Phone <br /> Installation will serve: Residence ®impartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _, ---- Number of bedrooms�--_ Number of baths __Zn Lot size �?----------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 6__rft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla E] Adobe�fiardpan F]Previous Application Made: (If yes,date.__..__.--,--------I No lew Construction: Yes o ❑ FHA/VA: Yes g-`I�o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r <br /> Septic Ta Distance from nearest well__.�Distanc om foundation__. l�_--___Materia�_- G_.���C- LL_ <br /> liloll <br /> No. of compartments-----q,—�---------Size_- -----Liquid depth__.' l-y------------Capacity..__ 1y------ <br /> Disposal Field: Distance from nearest well------ _ -.Distance from foundation.---Q-......Distance to nearest lot line'/____ <br /> Number of lines-__-_-___ _ __ Length of each line_ _����---.Width of trench_c�_�,___ _________________ <br /> lir ,�----------- ------ � <br /> Type of filter material-----1"4Gk-'----Depth of filter material_—/ ---------Total length -/------------____________ <br /> Seepage Distance to nearest well_ __Distance from foundation___,` __ __.Distance to nearest lot line_ ---_____ d <br /> Number of pits-------- ­'_ -__Lining ___Size: Diameter_1_13_3_`�_..___DepthQ7-f � T----- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_-_-----------------Lining material--------_---_---_____________________. <br /> ❑ Size: Diameter--------------------------------------Depth--------rl------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well ___-__-_______._________--._____________________Distance from nearest building------------------------------ <br /> __----_- <br /> ❑ Distance to nearest'lot line-------------------------I--- -- ------------------------------------•--•------------------------------------------------------- <br /> '� w /f����/� /W <br /> Remodeling and/or repairing {describe�:_y--"-`- '� '�"'i"------------.��- ---- -•----------------------------••-•-------------------------------------------------------- <br /> ------------•-•---------------------------•-------------------------- •--------- -----------------------7------- ------------------------------------------------------------------------------------------ <br /> t - <br /> --------------------------------I--------­­---- <br /> __:--------------------------- <br /> _________________f------------ _--_.-__._________--__-______i______-_.________----_____________-_________-________________________-_--____________________________,,_________________----________----_____-___._.___.__-____ <br /> I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I s, d rules a e ulations of the San Joaquin Local Health District. <br /> Si ned �__ ______ _____(Owner and/or Contractor) <br /> a-- ------- - - <br /> �y::'--•-------- ---- - --(Title] ' --- ----- - --- -- -------------- <br /> (Plot plan, showing size i ot, lotion of s em in relation to wells, xuldings, etc., can;be placed on reverse she]. <br /> FPy,P,WRTM,5KT USE LY <br /> APPLICATION ACCEPTED BY,,-__, -- ---- --- -----T____ <br /> ----------------- DATE--- --- - ---- --- --- --------- ------- <br /> REVIEWEDBY-------------------------------------f*--*--------------------- ------ ------ ----------- ----. DATE------------------- - ------------- <br /> BUILDINGIPERMITISSUED-------------------------------------------- --- --------------- DATE------------------ ------------- ------------------------- <br /> Alterations'and/or recommendations------------------------------- ------------------------ -------------•----------------------------- ------------------------------------- <br /> ------------------=�------------ ---------------•------------------------------------------ -- ------------------•------------------------------------------------------------------------ -<-------•--------•---------- <br /> FINAL INSPECTION B :.-- -------- --- -- -- --- - --------- - ---- Date ------ ----------- <br /> AN JOAQ IN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasolton-Ave. 300 West Oak Street" 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> CS 9 REVISED 6.59 am 3-•63 r.P.CC. <br /> s � �' <br />