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FOR OFFICE USE: <br /> . ............ ................... <br /> ............. APPLICATION FOR SANITATION PERMIT Permit No. ....................... <br /> ................................................. <br /> ....... (Complete in Duplicate) <br /> ............. ........................ Date Issued ........ <br /> -----­- ............. This Permit Expires 1 Year FDate Issued <br /> ----- ----- rom �_ Is <br /> application is hereby 'Made to the San Joaquin Local Health District for a permit to ccnAct�install the work herein deis'crlmecl. <br /> This application is made in compliance with County Ordinance No. 549. <br /> .............. <br /> JOB ADDRESS ANT? OCATION../ ... ...". ........0Z....... <br /> . . ................ .... Phone-----------------------------....... <br /> Owner's Name-- ... ......... --------........ ........ V <br /> Address----..._ ...... ZPP/..... ....................... .. ....... ---------------- <br /> 417 % <br /> Contractor's Name- Phone..........................I........I <br /> Installation will serve: 'Residence Apartment House El C.ornmercial 0 Trailer Court El Motel 0 Other 0 <br /> I Number of living units: ..1... Number of bedrooms Number of 2iths �._ Lot size ---------- ---------------------- <br /> Water Supply: Publicsystem [I Community system m El Pr Depth to Water Table ..76 ft <br /> 7- <br /> Character of soil to a depth of 3 feet: Sand F ravel 0 - Sandy Clay Clay Adobe G <clobeCl Hardpanx! <br /> Previous Application Made: (If yes,date................. ..) No 0 New Construction: Yes 0 NoEl FHA/VA: Yes [I NOOAfir <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: \1 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> eptip-T1 ko Distance from nearest well-________________Dista-nce from foundation----:.......... _------------------ .................. <br /> No. of compartments........... ------------."----------Liquid <br /> ----------Liquid dep+h........................-Capacity--------_--:.--------- <br /> Dispos ie Distance from nearest well__,c5.9P..".Disfance-from foundation A?.._'#.__..,Distance to nearest-lot line......S....... <br /> T 'Z- rn <br /> Number of lines___.-.-... v;?- ;>_.Length of each line. ....Width of french__�,_.--------------------­.. <br /> Type of filter material.7.,_i�...... Depth of.filfer material......11y----------Total length.....__ <br /> Seeps it- Distance to nearest ...Distan�ce/fr..Im k*ndefion.... Distance to near 10- <br /> ......Depth ........... 1 <br /> -,,,Size: Diameter__. -lax- <br /> Nu <br /> Number of __:F........Lining 4� '. I' .­*". �r <br /> Cesspool: Distance from nearest well......__-------Distance from founclati6i�....................Lining material.__:-:--------------------------------- <br /> ❑ Size: •DiameterA-------N---------- ---------------�Depth-------- •................ ................Liquid Capacity_-------.............._..gals. <br /> -0 N <br /> •Privy.. Distance from,nearest well___:_._.___.. ...........----------------Distance' irom nearest buildincj_ __.------------------_-------------- <br /> - - ­­-­..... ................. .............. <br /> ❑ <br /> Distance to nedre`s}-Iot,line___io:.................................... -�4.................................... ­ .... <br /> ............................................... <br /> Remodeling and/or repairing (describe):.----------------- - ......-------- ------------t k­e--------------------- <br /> s 14 <br /> -----------­ <br /> .............................­....... ............................:........................I------------------­ ............................ 7�----------- ----------------------- <br /> . --- <br /> --------------- ........... ....................I.............................. <br /> -------------------------------- -_------_---------------------------------------- ....................... <br /> ............. ......-1-----_------_ <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 law jand rules and regulations of the San Joaquin Local Health Disfiid. <br /> .....................-.-(Owner and/or Contractor) <br /> ........ ........ ............. <br /> (Signed <br /> By:._..... . . .................. ------- .......................... .................. ......... <br /> (Plot plan, showing size of lot system location of s teim in r ion to wells, buildings, etc., can,be placed on reverse side). <br /> FOR DEPAP.TMEN-T-USE-ONLY—,,.!--"�.,�i <br /> ................. <br /> APPLICATION ACCEPTED .0Y..... ................................................ .......I OATE <br /> -* , ......................------------------- <br /> REVIEWED BY............._---------------------------------------------------------------------- ........ DATE.,:, <br /> 6A -7 <br /> ..,::7T ---------------- ....... ----------- <br /> BUILDINGPERMIT-ISSUED.._.................••----•----------_------------- - ----------- <br /> .......... <br /> Alterations and/or recommendations:_ ......................................... ... ........... <br /> ----------------*1-----------------*- -----­­ � J., - <br /> 4 .............................................. <br /> ............. <br /> ............................ ................. <br /> .....__._...•-•••-................. I <br /> ........... .........................___........I.................................. <br /> ----------­ <br /> ..........I............................ ......... ........*......*-------- ---------------- ...... <br /> II ......................................................................................................................... <br /> ............................. ................... ................ .......... <br /> .................... .........I...­-­----------------------------- <br /> .................................. ......................... ....................... .............. <br /> ................................... <br /> -FINAL INSPECTiC ...... Date_�--------------------- <br /> N _7 <br /> LTH"69TROTS��'k <br /> SAN JOAI�IbhlS EA <br /> 1601 E.mamitan Ave. Soo West Oak Sfr"t 124 Sycamore Street 205-West9th Sft"t. <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> CO 9 REVISCM 9-59 31A 3.162 "'Cal <br />