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FOR OFFICE U,S <br /> -_-__/� /-----..-„ - APPLICATION FOR SANITATION PERMIT Permit No. .]. <br /> .___--_.___Lf _--> --- (Complete in Duplicate) 5 A� <br /> D r Date Issued -----1�-.----.•--- <br /> ---------`�--- ---------/ --.I.3 <br /> This Permit Expires ] 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 OC TION -- �,----- - � --------------------------------•--••-•---•-•---- <br /> Owner's Name------- ------•-------------•---------------------------------------------------- Phone--- ---�-31-4_0 - <br /> Address , --. .. ti -••-•-•-••••---------••-------....•--•-..... <br /> Contractor's Name--- = = (led. 2-� .. ... Phone'.- <br /> ------•--- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ "'� <br /> Number of living units: J___ Number of bedrooms ____umber of baths ........ Lot�14e ...--__----_•---------------------------------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes �o ❑ FHA/VA: Yes ❑ No � - <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank:. - Distance from nearest well-----------------Distance from foundation-------------------.Material_--_----..---.................................... <br /> ❑ c No. of compartments--------------------------Size---------------------------- --Liquid depth--------------------------Capacity-•--_................ <br /> Disposal Field: °Distance from nearest well-.distance from foundation.... _ :_Distance to nearest lot line.... <br /> � LNumber of lines............../---------- --------Length of each line----------- Width of trench---.---:2_. V/ <br /> Type of filter mate rial:._-----Depth of filter material------4`f___r�--.Total length............ ------•-_-.r.-_--- <br /> Seepage Pit: , Distance to nearest welL_. Y____Distance from f ndation-.-3._(�__.....Distance to nearest lot line__- ..:1 <br /> Number of pits............. -Linin material..., _._-Size: Diameter---..- -�`�---.Depth_-._.... .�- --------- <br /> p. < F . , . g <br /> Cesspool: Distance from. nearest well----------------Distance fromJioundation--------------------Lining material-------------------------- ------ <br /> ❑ r Size: Diameter_`_-------------------------------------De Depth -----------•------ --•---•--------Liquid Capacity----------------------------gals. <br /> Privy: r Distance from nearest well-------------------------------------------------Distance from nearest building--__-------_----___-_--................ <br /> ❑ I Distance to nearest lot line-------------------------------------------- -------,--------------------•-••----------------------------...-._....--....._------------------ , <br /> Remodeling and/or repairing (describe):-------- -----------~---------•------------•-----•-••------------------•--•-------•----••-----...............---•----------.. ....................... <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, to laws, and rules and regulations of the San Joaquin Local Health District. n <br /> 5t ned -_-__.Owner and/or Contractor <br /> iB •--•-.... -----------------------------------------------------------------------------------------------------------------------(Title)----------......... -------------------------------------------- <br /> (Plot <br /> ------------------- --- ------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. <br /> i I A FOR DEPARTMENT USE ONLY ' <br /> '4 APPLICATION ACCEPTED BY-- '`- DATI l <br /> I REVIEWED BY------------------------------------------ <br /> ------------- --------------------------...--•------------------------------------ DATE......................................................... <br /> .:- <br /> BUILDINGPERMIT ISSUED....... ------------------------------------------------------—-------------------------------------- DATE................---•••-- ........ <br /> Alterations and/or recomm nd'ations-------------•-- ---j-------------------- ---------•-------------- --•---- <br /> r rr, j <br /> ------------------------------ <br /> --•---•----------- ._.........------ <br /> .................. <br /> .--------------------------------------------------------------------------------------------------- ----­---------I....... ...... <br /> -- •-•-------I.....•.-.._....... <br /> --•----------•--------------------------------•• ------------------------------------------------- --•---------------- <br /> j <br /> FINAL INSPECTIOBY:_- L_x_._ ---------------------------------------------- <br /> 1161&_- Date-------I- Z--------------------------------------------------------- <br /> N <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street <br /> Stockton,California lodlr California Manteca,California Tracy,California <br /> ES 91 REVISED 8.59 QM 5-61 ATLAS <br />