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y FOOFFICE USE. <br /> 4 3 <br /> -3 ' � <br /> 1 <br /> - ------he - , r <br /> --------------------------------------- <br /> - <br /> -----------------------------:...... ........ ---------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------------------------- (Complete in Duplicate} <br /> -------------- -------------------- ------------------ I This Permit Expires I Year From Date issued 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 <br /> application is made in compliance with County Ordinance No. 549. <br /> e-1 <br /> JOB ADDRESS AND LOCATION -------C� 49 <br /> 4],�- ----- =4WK ------------ ........ <br /> X <br /> Owner's Name_/,; ._' <br /> -------- - --------Z<1_ ----------------- ---- --- Phone.. <br /> Address/ZZ/ <br /> Contractor's Name..__...�_ <br /> ...... ------------ -------------- ----- -- --- -------------•--............--....._ hone.......... <br /> Installation will serve: Residence Apartment House [] Commercial E] Trailer Court E] Motel ❑ Other [I <br /> Number of living units: __J--- Number of bedrooms 5�_--- Number of baths --/-- Lot size <br /> Wafer Supply: Public system El C I ommunity system [] Private Depth TO Water Table yrft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam El Clay Loam El Clay D Adobe tff Hardpan C] <br /> r New Construction: Yes I—] No <br /> Previous Application Made: (If yes,d'ate--------------------) No FHA/VA: Yes F1 No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> eank- Distance from nearest well_________________Distance from foundation--------------------Material <br /> No. of compartments--------------------------Size--------------------------------Liquid depth--- ------------ -•-------Ca aci <br /> Disposal ty---------------------- <br /> sposal I eld; Distance from nearest wellR,06....,_Distance from founclation..9?:5�----------Distance to nearest lot <br /> Er— Number of lines--,I___-__/-________________ Length of each line.... .. .........Width of french-------5??.5K-- <br /> Type of filter maierialffiof filter material---ZZ-------------Total length--------- ----- --------------------- <br /> Seepage Pit: Distance to nearest wellz,?A?4..........Distan m <br /> f U nclafion____�/A.-1------Distance to nearest lot line.:,e2l `d---_ <br /> Number <br /> ---- <br /> Number of pits----1_1------------Lining:,rnaterid Size:..Diameter___3,�..............Depth---- --------------- <br /> Cesspool- Distance from nearest well-----------------Distance from foundation---------------------Lining material__..___-_________._...______-_.-- L~ � <br /> ❑ Size: <br /> aterial-----------------I-­-------------- <br /> Size: Diameter---- I--------------------------------Depth------------------------------------------------fi.Liquid Capacity-----------_------_-----gals. <br /> Privy: 1 Distance from n6a rest well_________________________________________--------Distance from nearest building------------------------- <br /> J� _............. <br /> El Distance to nearest lot line-------------------------- I----------------------1------------- ------------------------------------- <br /> Remodeling and/or repairing (describe] -------------------------------- ---------------------- <br /> _7----- I I - <br /> ------------- ---------------­---------------------------------------------------1-1-------------------- ­-------------------- ------------------------------------------------- <br /> -----------------------•--------•--------...-------------.------------------------------------------------------------------- <br /> II -------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------- -----------------------------------------11----------------------------------------------........------------------------------- <br /> I herefbce ify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> r <br /> ordinances fa laws, 6 aoid rules and'regulations of the San Joaquin Local Health District. <br /> (Signed)....... . A------4 ...... <br /> — ------ ------ ---------------- n------------------------------ --- - 04ner and/or Contractor) <br /> By:------------------------------------------ _(rfle). <br /> ---------------------- -- --------- <br /> (Plot plan, showing size of lot, location of system in relation to we!6buildings, etc., can be placed on reverse side). <br /> FOR DEPA <br /> ,,RTMENT USE ONLY <br /> APPLICATION ACCEPTED ----/_ <br /> ------------- <br /> ------------------------ ----------- DATE- <br /> REVIEWED BY I <br /> --_----------------­-------------------- ---------------- - - ----- ------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED <br /> ------------,-- <br /> � ?--- ------ --- -- ---- Z_ DATE <br /> Alterations and/or.recommendafions:;Ir -0/I---- -- - ... .....I........ <br /> .. <br /> ---------- ................. ---------------­---------- <br /> • <br /> - ---------------------------------------------------------------I I-------------------------------------------- ----------- ------------ *-------------------------*-----------------------------------------*-------------- <br /> ---------- ------------------------ --------------- ------------------ - ------------•-----------•-------------•-------------• ------------------------------------------------ --------------------------------------- <br /> ,I <br /> ----------------------------------------------................. ---------------- ­ __ ------------- -I------------ ------------- ----------------------------------------------------------------------------- <br /> ----------------- .................... ..... --- -----­----------------- - ------------------------ -------------- ---------­---------------- -------- ----------------------- ------------------- -------------- <br /> FINAL INSPECTION - -------- -- ---------- Date-/------ --= ' 4 -0 <br /> —k <br /> SAN JOA UIN LOC HEALTH DISTR T <br /> 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodir California Manteca,California I Tracy,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br />