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FOR OFFICE USE: <br /> ----------------------------- ------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..1-6............ <br /> .............. ---------- -- -------------- ------------- <br /> --------------------------------I--------- --------------- (Complete in Duplicate) 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 descr ed <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS,AND LOCATION <br /> ------— ........ - hone---------------------- <br /> Owner's <br /> 4f-- --------- .. -------- <br /> ,A= -4 --- - home---------------------- <br /> Owner's Name-- 0-40 -------------- <br /> - <br /> Address.........................----••---•-••-•••-•-•-----------------------------------------------------------------------------------------­------------ ...... <br /> -------------------�/`�=........ ..................----------- <br /> Contractor's Name.. <br /> Installation will serve: Residence [0 Apartment House [] Commercial E] Trailer Court 0 Motel 0 Other [I <br /> 10 &&%At&........ ------------------------- <br /> Number of living units: .1- Number of bedrooms -------- Number of baths -------- Lot size --- -------- ......... <br /> Water Supply: Public system 0 Community system C1 Private R] Depth TO Water Table -.7-0 ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel El Sandy Loam 2] Clay Loam 0 Clay [3 Adobe[3 Hardpan <br /> Previous Application Made: (if yes,date_.__..___,___.__--) _No-K ,,,,New Construction: Yes Z No El FHA/VA- Yes [:] Na [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool Permitted if public sewer is available within 200 feet.) M.aterial---------------­------------­................. <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------- -------- <br /> F] No. of compartments..-------------------------Size--­-------------------------Liquid clepffi---­--------------------Capacity----------------------- <br /> W-- \ J.P..........Distance to nearest lot line--4��.......... <br /> Disposal Field: " Distance from,near�st'well*.o--------Distance from foundation-- <br /> * *L. ch------- -1---------------- <br /> j,,,Number of lines---------I------------- Length of each line----- ----------------Width of tren <br /> Owell________________ <br /> A <br /> % --Total length..- - ----...----....---•- <br /> -n------------------- --------- <br /> Depth of filter materi IPIA, F ------ ------- <br /> Type of filter material Feepage Pit: Distance to nearest well-----­­----------`:-Distance fromafounclation--__._...__________.Distance to nearest lot line________--_______ <br /> ❑ <br /> ine----------------- <br /> El Number of pits-- ------Lining material _I-•-------------Size: Diameter------------------ ----Depth--- ---------------------------- <br /> 7 <br /> Cesspool: Distance from nearest well-----------------Distance from founclatior�---------------------Lining material____---_.______.____._.._____.___.__.Size: Diameter--------------------------------------Depth--- -- --------- ------------- -------. . -Liquid Capacity----------------------------gals. <br /> El -- -- --------- <br /> Privy- Distance from nearest well---------------------------------- ---------------Distance from nearest building-------- •------------------ ----- ------ <br /> I <br /> Distance to nearest lot line---------------------- ------ ------- ----------- ------------------••--•-----•-------------------•-------- ----------------------------------- <br /> ❑ <br /> Remodeling' I - <br /> mand/or repairing (describe):--------------------------------- -------------­--------------­------------------------------------------------­-------------------------------- <br /> ------------------------------------I-----------------------------------­-------11--------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------ <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 /> --------------(Owner and/or Contractor) <br /> -- -- A --------- <br /> (Signed.0"4 _410, -­---------------- ----------------- ----------------------------------- <br /> -------------------(Title)----------- -------------------------------- -- -------------- <br /> 'y ------ Ida)— <br /> (Plot plan. s owing size o lot. location of system in relation to wells, buildings, etc., can be placed on reverse side}.-•_-- <br /> FOR <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ------------------------------------•------------------ DATE--- ----------------------------- <br /> REVIEWEDBY------------------------ -------------------------------------------------------------­--------- DATE-------_ ------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------–-------------------------------------I DATE------------------ ----------------------------------------------- <br /> Alterations and/or recommendations;-------t------------------- ------ ----------------------------------------------------------------------------••-----_-.----_--•---•---•-------.....--------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------I---------------------------------------------------------------------------------------------------------------------- --------- <br /> ---------------------­----------------------------------- -------------------- ------------ <br /> ....... ....I----------------- ------------- --------------------------------------------- -----------------------------­------- <br /> ----------------------­----­.................... ------------------ - -------------------------------------- ------------------- ----------------------------------------------- --- -----­--------------------------- <br /> FINAL INSPECTION -------------------------- Date--- -------------------------------------- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California "4-1 Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />