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FOR OFFICE USE: ti <br /> APPLICATION FOR SANITATION PERMIT <br /> r Permit No. . .._.. ._..... <br /> -------------------- t <br /> —(Complete in.Du Itcate �--•-�–•----w------- - -- <br /> • - — <br /> --------------------------------------------_------------ This Permit Expires 1 Year From Date Issued <br /> 1 414 <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. 6#^-14- <br /> JOB <br /> #^-1 GJOB ADDRESS O 1 N_``---•--- <br /> t <br /> Owner's Name <br /> �*� lG�°�r_7 r s_. Then -!_ <br /> Address-.--•-••...._.....--•------- �. 1!1b., ------- -_ ---------------- - - <br /> --�..,.� <br /> I ,* --------------------------- <br /> Contractor s_Name= .... { '[,C;�-. �.fry -`---- �---••--------.----Phone <br /> Installation will serve: Re ' e c Apartment House .Commercial ❑ Tr 'er Court ❑ Motel � Other <br /> ------- <br /> f# <br /> Number of liviri'g�uni r.: '"rkNurrikier of 6edroomsNumber a; b the #.+Lotie ._._ __LO <br /> t� �T <br /> Water Supply: Public system", <br /> �=Commmun�ity�system❑ Private Depfh�pTo?Water Table___ .. ft. <br /> Character of soil to a depth of 3rfeet: 'Banda❑'. Gravel [3Sandy Loam E] Clay Loam ❑ Clay []Adobef Hardpan ❑ <br /> Previous Application Made (If yes,date.__.___�__ ___` ) NoX New Construction: Yes `'+No ❑ FHA/VA: Yes ❑ No <br /> I TYPE OF, INSTALLATION{ANO SPECIFICATIONS: /// <br /> (No septic tank or cesspool pe'`rmitted if publir.liewer is available within 200 feet. �q <br /> 11 I) "1 � 1. '----- _ <br /> Se tic Tank: Distance from nearest rest wail_ ._ ___jhlkpistan fr m �Yun a�on.1 _ ..__�_��.Material_ _.____.____S/- ..- <br /> F-- - 1.Liquid depth---- r. CaPacity.. �i � 1 <br /> No. of tcomparfinents-------- - ---Size— ..____ / <br />± y} f�. ______....Distance to nearest lot lid. <br /> Disposal f=i01d: Distance from ne�re wel!_r�(!_._______Distance from foundation_. _ <br /> ___ . Length of each line_______ Width of trench___.___ <br /> t Number of lines_ __ _ ________ ______ g �� - <br /> { TAe of filter ma erial-.5 - <br /> _0 <br /> �Ci Depth of filter material.____ _ - Total length_.________. .-_ ••----- +� <br /> 1�--------- <br /> Seepage Pit: pstace to nearest well______________________ istance from foundation__....______.---._..Distance to nearest lot line-------�.______. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--•---------...---......`--------. <br /> Cesspool: pistance from nearest well_________________Distance from foundation--------------------Lining materiel----------_-----------------E-------- <br /> Li uid Ca act .,gals. <br /> t ❑ Size: Diameter--------------------•-----------------Depth--------------------- ----•-------------------- - q P ty--•-------•--•--------•• <br /> Priv Distance from nearest well-------------------------------------------------Distance from nearest building <br /> [I Distance to nearest lot line----------------- -------------- - -•----------------- 1 & <br /> ....1 <br /> Remodeling and/or repairing (describe):------------L---- --- -•-------- -- --• --- -------••-•-•-- <br /> I --------••-----{--•---------------------•-------• ----••-.._..---------------•- -. ----------- <br /> ------------•---------------•----------•----------•-------------------a--------- <br /> J <br /> ....-------•--------------•-----------------------•--•--------•---------------------------------- •---- <br /> ieb certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cf <br /> ------------ ---------- ---------------------------------------------------------•-•---------._._..-----------•------------- <br /> ! <br /> hereby oun <br /> ordinances, St to laws, an u a egu 'ons of the San Joaquin Local Health District. <br /> (Signed).- ---------•------------------•--------------- {Owner and/or Contractor) <br /> 9 .� •• ------•---•- ----- - --- <br /> $y:. - ------------------- --------------------••----------------(Title) <br /> _... <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 ---- -- DATE.. r <br /> ---- <br /> REVIEWEDBY------------------------------ ------------------•-------------- •-­­. DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED-- DATE <br /> ---------- <br /> Alterations and,Apr recomm nr ations:____•-� �-- -------- `- ... ''-• - <br /> - ------------------------------ -- <br /> . <br /> ........cam--- � / <br /> -- '� -Y <br /> FINAL INSPECTION BY----- ---------------------- ------------- ------ Date------------------------------ -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sireet � 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 1 ES 9 REVISED 8-59 2M 5-62 ATLAS ti <br />