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FOR OFFICE U E: <br /> _ /f .. 4-- ----------- <br /> -.--_ _��,.�-------------- APPLICATION FOR SANITATION PERMIT <br /> Permit No. .___f. �. ...7. <br /> ------------------------- ---�-------------- (Complete in Duplicate) 7 <br /> ---------------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance wl Cou ty Ordinance No. 549. <br /> 7 <br /> JOB ADDRESS AND LOCATION-------- '.. d ne" ----------------------------------•- -•-----------------------•---- <br /> Owner's Name <br /> lC'.0 -----•--------- <br /> .77 -- <br /> AddressJ = <br /> r v ' <br /> ----- <br /> k - <br /> Contractor's Name------- - 41 . <br /> ------•-- Phone....._-_-",----.--• -- <br /> Installation will serve: Residence [W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. ❑ <br /> Number of living units: --- ---_ Number of bedrooms _- Number of baths _- Lot size ... -__.-51 <br /> Water Supply: Public system Community system Eli-Private jK Depth to Water Table _5f Sft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ <br /> Previous Application Made: (If yes,date--_--'-'-A.........) No1� ' New Construction: Yes"W No ❑ FHA/VA: Yes ❑ NoEj <br /> TYPE OF INSTALLATION AND 5PEC(FICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)f <br /> Septic Tank: Distance from nearest well /Z� Disfarice from foundation._.- <br /> No. of com artments----- ---------------- Liquid de--_-t-_h_---.-M_---a--tfeer!i------------. <br /> ---__----.. ------------- <br /> Ca aci -... <br /> Disposal Field: Distance from nearest welll exl�_Distance from fouyafion-..../,a/_---.Distance to nearest lot line----- <br /> Number of lines_______________ .Z'----/--Length of each line-°--_---. Width of #ranch:..-.. - <br /> Type of filter material ,-'gn�/- epth of filter material--._._-_--l -��---Tota! length=.--.--- f--- ---- <br /> Seepage Pit: Distance to nearest well-- - istance from foundation---5e Distance to nearest lot line__- - -_ <br /> Number of pits------- ------------Lining material-- �..---Size: Dialmeter._=- _��_.:---Depth----.-- ...... ....... <br /> Cesspool: Distance from nearest weJ1-----------------Distance from foundation....--------.- --Lining material------.----------------_------------- <br /> ❑ Size: Diameter------------------------•-------------De th--------------------------------------------------�Li9uid Ca aci <br /> tY---------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------------_- <br /> ❑ Distance to nearest lot line------------------------j-----------------------------••-------•-------------------------------------------------------------- ------- <br /> 2 <br /> Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <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 /> (5igned)-- -- - ­— <br /> ( / <br /> 13 (Title)- -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FO DEPART ENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ---------------------------------------- DATE.---- ---------- <br /> REVIEWED BY-------------------------------- ------------ ------------------------------- -•---------------------------------------- DATE--------------- <br /> --- -- • ------------------------------ <br /> BUILDINGPERMIT ISSUED-----------------------------------------------------------•-------------------------------- ------ DATE.---------------------------------------------------------•- <br /> Alterationsand or recomm dati ns:-------.------------------ <br /> ------- <br /> ------------------- C.% <br /> ------ <br /> - -_.- .- •---------------- - •-•-.-•- _•-� 4 ------------------------- -- <br /> ------------------------------ <br /> ff <br /> FINAL INSPECTION BY:------ --- = C�------ ------------------------------- Date------------- 1 4 - ----------------•--•--------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES-9 REVISED 5-59 F.P.CC.2M 6-613 <br />