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FOR OFFICE SE: <br /> ---. ._-.-------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> .................. ...... .................. (Complete in Duplicate) Data Issued .. 3.7� ...(°.. <br /> 7.— <br /> _..___.......................................,. is Permit Expires 1 Year From Date Issued <br /> pplication is hereby made to the San Joaquin Local Healrh District for a permit to construct a d i stall the work herein described. <br /> (his application is made in compliance with County <br /> �� Ordinance No. 544. ""'y f a <br /> 1:14 <br /> JOB ADDRESS AND LOCATION_��0.._.f__4 - -� -._ <br /> e <br /> Owners Name__ ___. . _ _�._. Phone..................._............... <br /> Address •'..If— �-liP,, ..... ..... .. .................._•-•..-------.........•.........................----------•- .................---•.................... <br /> ._.. <br /> Contractor's Name............ .' --• .............. Phone----_-•--------••-•---•-....._. <br /> tnstallation will serve: Residence 'Apartment House ❑ Commercial 9 Trailer Court ❑ Motel ❑ Other ❑ <br /> ss�� <br /> / <br /> Number of living units: __/.. Number of bedrooms S._ Number of baths S- Lot size � _ _�c'f*'�4,�'........................... <br /> Water Supply: Public system ❑ Community system ❑ Private g?"Septh To Water Table469P ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe 80"Hardpan❑ <br /> Previous Application Made: {If yes,dote---.--------.__ .__) No New Construction: Yes &/Rio ❑ FHA/VA: Yes A` No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: \ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)/ <br /> ,Septic T Distance from nearest. -,--i -__..Distaacefromfoundation__�0 <br /> ----------Material---L � _____________ <br /> No. of compartments. - _.Siz&V!uA ! KVpLquid <br /> depth....11W�...__...._----Capacity./2449._. <br /> isposaI old: Distance from neare��jjweli.,$-P...._Distance from founds ' n 16p-------Distance to nearest log <br /> Number of Imes......9 ►. .. _. Length of each line.97e _-. Width of trench:_.e! ____ ____________________ <br /> Type of filter material C(_e._ ( Depth of filter material._/f .-....Total length.-.94A9....................... <br /> asps rt: Ar <br /> Distance to nearest well_.Z je..._-_Distance from foundation____Z,P_._....Distance to nearest lot li� `�....�_.-_______ <br /> Number of pits_.-.A............Lining material. 9 .4e! _._.Size: Diame+er ..............Depth.,2.47..__-......... <br /> .._... <br /> (Cesspool: Distance from nearest well,............._Distance from foundation--------.-..........Lining material...._------__--------------....... <br /> ❑ Size: Diameter------------ .._.. ................Dept h...................._...............................Liquid Capacity............................gals. <br /> rvy:. Distance from nearest well................................................Distance from nearest building----------------------_._.._-_..__._-____. <br /> Distancefo nearest lotline........................................................................................_...._.. ..............................___---------- <br /> �� ✓ <br /> delity nand/or repai 'rg (describe :.� ___.. 901 ............... <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, nd rules and regu tions of the San Joaquin Local Health District. <br /> (Signed)-------- _ --------- -------- - - j dAor Contractor) <br /> A <br /> By;.......................................................... -• -...._... (r+le)_ 's// /lam...._ <br /> (Plot plan, showing size of lot, location of + m in relation +a wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.'t/-= "'_.- -"•• ............ ....•............. .:.-_3 i'�. ..:-....... <br /> REVIEWEDBY...--..........•.............. ----------.._.......----------------------------------------------------------....... DATE............................................................ <br /> BUILDING PERMIT ISSUED....................... ...........I...... 1 DATE j. <br /> Alterations and/or recommendations:...f ?,R, -.�'`.1 ._ <br /> r <br /> ------•- ..-•----.....-_---•--.------•-- ---------------------------•-•--- ..................................................... ........................................... <br /> --------------_........ ....................*....... .................................... ......._...... _.. <br /> FINALINSPECTION BY:... ...... ...... ..---- .._...._. Date...-................ .. .... ....................................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wast Oak Street 124 Sycamore Straat 205 We/t 9th Street <br /> Stockton,California Lodi,California,; i Manteca,California Tracy,California <br /> ES 9 REVISED B-89 2M 5-452 ATLAS <br />