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APPLICATION FOR SANITATION PERMIT Permit No. _-l .T _•cJ- <br /> (Complete in 'Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date issued __-� <br /> Application is hereby made to the San Joaquin Local Health Distri'Lt for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. k-\"�0ls <br /> _- ---_ : <br /> -------------- <br /> JOB ADDRESS AND LOCATION_---------------- <br /> Owner's Name------ _`+ _._ `------ •---------------- <br /> 1-902, hVit" <br /> Address----•-------------- ---- --------------------------------------•---=---------------.. ------ -----•1.1-1-------------------- <br /> Contractors Name-- -------- k �---4tgr �- ----• ----------------- ---------- <br /> Phone ._ <br /> Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ _-_ Number of bedrooms --- Number of baths _ --__ Lot size ------ ------------------------------ <br /> Water Supply: Public system ❑ Community system [A Private ❑ Depth to Water Table4 __. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [n Hardpan ❑ <br /> Previous Application Made:,,Yes ❑ No [;I New Construction:. Yes"& No ❑ FHA/VA: Yes [A No ❑ <br /> r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> joil, CC trick <br /> Se tic Tank: Distance from nearest well-2,""__- ----Distance ,from foundation------- ----_Mat rial_--- ---_ -------------------------------- <br /> p] + ._ .L, uid de th r --------- <br /> Ca Capacity <br /> No. of compartments- ¢e-________,. q p. P tY <br /> Disposal Field:� Distance from nearest well - -Distance from foundation.-- ----------.Distance to nearest lot lline ------------- <br /> Number, of lines -' x ---Length of each line-'--' .Width of trench _-- ------ <br /> 11 ----Y - filter material-----C--, --- Total length---- --------------------------- --� <br /> See age Pit: Distance to nearest well .-_-Distance + <br /> Type of filter material_ ._ �"�� -De th of <br /> g <br /> from foundation-_ "__ .___._.__.pitance to nearest lot line- ____-._ <br /> !- CA <br /> Number of pits._.- 2-------------Liming material-------- iit� Size: Diameter---- "_-------------Depth------_-------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance!from foundation--._---------------Lining material-------------------------------------- J <br /> v ❑ ---------------------Liquid Capacity-------------------------•-gals. <br /> y. '------ ------------Dep#h----,�----------- --------- - <br /> Priv Distance from r nearest well--------------------------------------------------Distance from nearest building---------------_---------- <br /> --------- --. <br /> t ❑ Distance to nearest lot'line------------------------------------------------------ -•--------••- ----------------------- -----------------•• ---------------- <br /> ,. <br /> NOW ftp k-t-_-1GY-6te �''-------------•------ <br /> Remodeling and/or repairing (describe):----------- --------- <br /> -----------•------------------------- ---- - ------- ------- --------- <br /> ------ I--=--------------------------------------.---------------------­1----------------------------------------------------------------------- ------ <br /> f ----------------------------------------------------------------;------•----------------------------=---------------------------------•---•-------------------------------- --- <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 /> lL� a61I1i` 4tllI --------- ----- -- -- ------------- Owner and/or Contractor) <br /> ------------ <br /> (Signed)------------------- ------------ ---- --------Iii -• ` >rt6 <br /> By• ____ _ ________ ---(Title)----------- <br /> --- •----------------y---- --- <br /> (Plot <br /> - , <br /> ( plan, g ells, buildings, etc., can be placed on reverse side). <br /> Piot lan, showing size of lot, location of s st in relation to w <br /> FOR DEPARTMENT USE ONLY <br /> r -------------------- <br /> - <br /> APPLICATION ACCEPTED BY------------ --- -- --------- ••-------------------- DATE-------------------'----- ,._ <br /> ---------------- <br /> REVIEWED BY----------------------------- ---------------------------------------------------- <br /> DATE------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------- • = .......... •- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-----------�:n_ -•---------•----------•--------•----------_----------------- -----------------------------------•------- <br /> ------------- <br /> -- - --- ------ <br /> ----------------------••---- -•-----------•--•------------------------•------•---------------------•-- <br /> -- - -- <br /> FINAL INSPECTION BY:.. - ----- -- <br /> Date- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> A• <br /> ES-9-2M REvised 8.'59 P.P.Co. <br /> r <br />