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FOR OFFICE USE: <br /> ------------------------------------------ ------------- <br /> ------------------------------ <br /> ______--___------. APPLICATION FOR SANITATION PERMIT Permit No. ..cr--1 _--. <br /> -------------------------I------------------------------- (Complete in Duplicate) <br /> Date Issued <br /> ---------------------------------------------------------- This Permit Expires 1 Year From 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 AND LOCATION-------- ------M.A--------Lo- ------ "n- Ce,.«,.R,5------ 9---d------------- ------- <br /> Owner's Name-----------------Tr-r9 r. 0..Av—s------•Mil , In----------------------------------------------------------- ----- Phone------------------------------•--� <br /> Address....---------------------Q.t------ � 1Y �a��_-..... <br /> ----------------------------------------------------------------------•--•----------------•-••-•-- <br /> Contractor's Name-------------------------------------- -------------------------------------------------------- --•------------- Phone--------------------------------• , <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial [❑ Trailer Court W Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms ------.- Number of baths ----:--- Lot size ---- ----------------------------- <br /> Water Supply: Public system ❑ Community system W Private ❑ Depth to Water Table -�--_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam,M Clay ❑ Adobe ❑ Hardpan <br /> Previous Application Made: (If yes,date--------------------) No 8 New Construction: Yes Er No ❑ FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS:(No septic tank-or cesspool permitted if public sewer is available within,200 feet.)' <br /> I <br /> Septic Tank: Distance from nearest well-_-_I. Q---Distance from foundation-_1167--.MateriaLC_c,,VC .Q7-.-�------------No. of compartments----------.-r -----------Size__ 0.-X.-(--�JI1--Liquid depth--...a—-------------Capacity---J-6oQ-o--f Disposal Field: Distance from nearest well--_L�?-. --Distance from foundation----�2-------.Distance to nearest lot liineO_0--Number of lines--------_ --- S -----------Length of each line---------�--Q jp------.Width of trench--------- ---------------Type of filter material---RaG-K-------Depth of filter material---1-t --------------Total length-------- -----_ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 11 Number of pits----------------------Lining material-----------------------Size: Diameter----------------------.Depth------------------------------._. <br /> Cesspool Distance from nearest well-----------------Distance from foundation--------------------Lining material-----..--_-_----------_---_--__---. <br /> ❑ Size: Diameter--------------------------------------Depth-------------- -------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------.--------------. <br /> ❑ Distance to nearest lot line---------------------------- ----------------------------------•-•--------------------------------------------------------------- ---------- <br /> Remodelingand/or repairing (describe):--------- -----------------------------------------------------------•---•-------.-....-------------------------------------------__------------------- <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, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------- - ---- --- ------ - ----------- -- (Owner and/or Contractor) <br /> ----------- C� = -_ ------ --------------- ----- <br /> )i <br /> _-- _ —_ =—=Title)=---:.;• - - ---------- <br /> By <br /> - <br /> (Plot plan, showing size of lot, location of s s+ in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B - ---------------••------•---------------- DATE---- Sr ' --------------------- <br /> REVIEWEDBY--------------------- ------- ---------------------- --- ------- ------------------------------ --------------------------- DATE.--------------------------------------•------------------- <br /> BUILDINGPERMIT ISSUE --------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:----------- .............. ------------ ------ -------------------------------------------------------•-------------------------------------------------------- <br /> ---------------------------•------------------------------------------------- ----------- ------------------------------------------------------------- -------------------------------------------------------------------­ <br /> ---------------- <br /> ..--------------- ----------------------------------•------..-------------------------------------------•------------------------------------------------------------------------------•--------------------------•------------ <br /> ------------------------------------------------•------------------------------------------------ ---------------------------------------------------------------------------------- - -----------------------•.------- <br /> --------------------------- <br /> FINALINSPECTIO N✓%.---- ------------------------------------------- Date--- -fJ o '---------------------------------- ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9.59 3M 3-'63 F.P.0 . tikes <br /> f <br />