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"FOR OFFICE USE: <br />_____----_----------------------------------_------------ APPLICATION' FOR° SANITATION PERMIT Permit No. <br /> -------------- - _ {Complete in Duplicate} ' <br /> __ _ .m.. _..__. . ,-- � .Date.Issued ....�Y <br /> Application is he"reby'made to th Son JoaquThis'in Local Haalth District <br /> From Date Issued <br /> M 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.-i.Y' _ --------------------- <br /> -------------------------------• ---------------------------------.....-•----- <br /> Owner's Name -------- --- -- Phone------------------------------------ <br /> Address_...a16 -9 <br /> --------- <br /> / I <br /> Contractor's Name------:-•.......... .. . -- <br /> Installation will serve: Residence PtApartment House ❑'—Commercial-❑ Trailer Court ❑ Motel'❑ Other ❑ <br /> � , <br /> Number of living units: _�__'_ Number of bedrooms _62__ Number of baths I___ Lot size ____C-Q _____________________ <br /> Water Supply: Public system , Corrlmunity system ❑ 'Private ❑ Depth to Water Table _y ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ <br /> Previous Application Made: {If yes,date_1_ _, C2__.1 No ❑ New Construction: Yes ❑ No [P-'FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permi+ted if public sewer is available within 200 feet.) <br /> t' nk:• Distance from nearest well_________________Distance from foundation-------------------Material----_______.______.______.___-:_-__..________._. <br /> No. of compartment--------------------------Size-------------------------------.Liquid depth----------------------- Ca pacify----------------------- <br /> Disposal Field: Distance from nearest'well-----------------Distance from foundation....................Distance to nearest lot line_________________ <br /> ❑ Number of lines_ I-j----------------------Length of each line------------------------------Width of trench----------------------------------- <br /> Type <br /> -------------------- F <br /> T e of filter material____._.____-____-_ <br /> yp epth of filter material-----------------------Total length------------__-._:_.. .--__--__------- i <br /> 1 �. f s S D <br /> Seepage Pit:-- Distance to nearest well- D+scan from oJundation___ _Q_________-Distance to nearest lot line____ _______ ' <br /> -- Dept ---------------- � <br /> Number of pits__!�__.�_--------Lining mate�ial6-- -/�-_.__.Size: Diameter----w""_,�__�1 p 0 <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 /> --------- 4 <br /> ❑ Distance to nearest lot line------------------------- ----------- -----------------------------•-- ---------------------------- <br /> Remodeling and/or repairing (describe):-------- '----------- --------------• ----------------------------------------------------.---------------------------------------- <br /> --------------- -----•----- <br /> ---------- ------••--------------------------------------------------------------------•-------------------------------------------•-•--•----------------------------•--------------------------------------------•----------- <br /> ---------------------------------------------------------------------------------------------------------- -•---------------• --------------------------------------• --------•-----••---------------------------------- <br /> I hereby cerci that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St t la s, and rules and 4reulations of the San Joaquin Local Health District. <br /> V(Signed) ---------- --- (Owner and/or Contractor) <br /> By:-----------------------------------------14 .r - ----- -- -• -------------------------------------{Title) --A------------------------------------------ - <br /> (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). <br /> I FOR DEPARTMENT US ONLY ' <br /> APPLICATION ACCEPTED BY-- 7•c � DATE-- <br /> REVIEWED <br /> ATE REVIEWED BY-------------'-------------------------------------------------------------------------------------------------••---•-------. DATE..- <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------—------------------------------------- DATE. <br /> Alterations and/or recommendations--------------- ....:--------------------------------------------------------------------------------------------------------- -------------•--------. --•--- <br /> ----------- ----- ? - -------- •----------------- --- -•------------`--------------------------- •---------------------------•---•----------------•------ -- <br /> ----------------------------------- <br /> ---------------- ._._.- . - :--------------------------- <br /> --- ------------------------ ------­­------------------------------------------------------ ----------------- -------------------- <br /> - ------------- <br /> FINAL INSPECTION BY:_� df--- Date------iS_ --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> CS-9 REVISE,5-59 F.P.00.2M 6.60 <br />