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- �+4 <br /> FOR OFFICE�SE:!(GPermit No. ... _( APPLICATION FOR SANITATION PERMIT -��;' <br /> --------- --------""-"-- (Complete in Qupiicate) Date Issued -__-•------ - <br /> '_ Issue <br /> This Permit Expires 1 Year From Date <br /> Application is hereby made to rthe San Joaquin Local Health District for a permit tp construct and install the work herein cLescribed. <br /> This application is made in compliance with County-Ordinance No. 549. -F,Q• �� t' 3�. V;� <br /> I - - -- -------- <br /> JOB ADDRESS A LOCATION___ __ ______ __ - h <br /> ` Pone.... L ?� <br /> Owner's Name_ &"--'----------"" <br /> - - - -- ------ <br /> Address----------••------------�-�-� ------- ---- -- ------- ----- ----------•----------------------------------------------------------------••-------••-•--- <br /> Phone-----------------------------------­--------------- <br /> 's No e.. _. -�• - ---- ----------------------------- <br /> Contractor'sInstallation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I <br /> _"- Number of baths __,/ ..Lot size .... - •••-- ••... <br /> Number of living units: _�__ Number of bedrooms � " " <br /> Water Supply: Public system ❑ Community system ❑ Private; Depth To Water Tablecnj.Q. ft. <br /> Character of soil to a depth of 3 fee� Sand ❑ Gravel [j Sandy Loam ❑ Clay Loam ❑ Clay [j Adobe Hardpan <br /> No ❑ <br /> Previous Application Made: (If yes,clate--------------------) No ❑ New Construction: Yes E] No FHA/VA: Yes ❑ + <br /> , y <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> [No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i Ta Distance from nearest well-----------------Distance from foundation___"...___-_____-.Material_____..""_.___...--------------.•••••-----• <br /> No. of compartments---------------- ------Size------------------------------- <br /> _A6 <br /> -•-------------------- Liquid depth Capacity ! <br /> Distance from near well.l�A._----Distance from foundatiop Q -•--- Distance to nearest lot I fe.. <br /> Length of each line_ 1-1q_ <br /> -4.0--.Width of trench.., "- <br /> tiQ <br /> �( Number of lines:__ _ ___ . _ P <br /> e th of filter material--- `----•--Total length------------------- g.40---------Type of filter material.. <br /> Seepage Pit'. Distance to near es well./0---.-------Distant m f ndation.,�Qrl ---.Distance to nearest lot line. ---- <br /> Depth -�-. <br /> ""-- -Size: Diameter__..3�------------ p --._._...._ <br /> Number of pits__ _ Lining material___ _ ..___ - <br /> Cesspool: Distance from nearest well-----------------Distance from foundatiorj.__...___.-.____.__.Linindg material <br /> gals. <br /> ❑ -.---• q Capacity Size: Diameter---=------- --------------------------DePth---•-- -------------- -------�-------------- _ <br /> ------------- -------Distance from nearest building:----------------------------------------- <br /> Privy: Distance from nearest well------------------❑ Distance to nearest lot line______"..___._.__"_. ------------------•-- <br /> ------- ------•------------------------------- <br /> -•-------------- <br /> Remodeling and/or repairing (deseiibe)-----------------------------------------------------------------------------------------------------------------..---•------•--••-----------..---------- <br /> ------------- <br /> 1 I -------------------"-------------......-------------------"._..----•"---- <br /> "•---------"------ <br /> --------------------------------- <br /> ------------ <br /> ---------------------•----•----------•------•------------ ------•-------••----------------- <br /> ( _______ _ ________ J ---•---------------------------------------•--- -------------------••--------•-----•----•-----•-•------------------"---------------•--------- <br /> I he"c ' hat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinanajddrles and r ulations of the San Joaquin Lacal Health District. <br /> I ---------------------------- (Owner and/or Contract <br /> d/a or) <br /> 8 -- ------ <br /> Y= -----[Title)----------------------- ------------------- -- -- ------ <br /> (Plot plan, showing size of lot, Iota flan of system in relation t ells, buildings, etc., can be placed on reverse side)., <br /> E FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> -------------- <br /> DATE f r' ------------ <br /> 5s ----------- DATE. <br /> i REVIEWED BY--- ------------------------- DATE <br /> ---------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------—•--------•----------------------- <br /> I Alterations and/or racom ndptions_-----------__ _-----------------•---- -------- ------------------ <br /> - -------------- �.� ._....-------_..- <br /> .1-!- -------------- -�- ------ --y-------••----- <br /> 1 <br /> ----- ------ <br /> 1 - - <br /> S, ..�-_3--------------------------------- <br /> I <br /> FINAL INSPECTION BY:_....j------- .... -- - ------ ----- Date_--cam._.._ ".�--------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> 300 West Oak Serest 124 Sycamore Street 205 west 9th Street <br /> G Stockton,California <br /> + Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED a-59 2M 5-62 ATLAS <br />