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FOROFFICE USE l`z-u eC w L. <br />-------------------------- --- --- -- ------------------- / <br /> ______________________ _ ------ -------__._. APPLICATION--FOR--SANITATION PERMIT Permit No. .. rp <br />- -------------------------------------------------- --- (Complete in Duplicate) a` -/G L <br />-------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued ....................... <br /> OMO <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 /> Q <br /> JOB ADDRESS AND LOCATION._ - -- -, ----- <br /> ---------------------------- <br /> Owner's Name_... .. a - ... ------•----------- -- � -------•-••------••-------------- Phone------------------------------------ <br /> Address..................- ,t ' !1 ----7.►�... ..-•---•---------•----•-------•.._.....----••-••--------•-•••••......-- <br /> Contractor's Name s.-------------------------------- -------------•--•-----••--------......-----•------•------------•----- -•--• --- Phone----...--------------.............. <br /> Installation will serve: Residence ❑ Apartment House E:]' Commercial ® Trailer Court ❑ Motel 1�1 Other ❑ <br /> Number of living units: .__. Number of bedrooms -___ Number of baths .. -_ Lot size .t:1_?-k_ ` _�__............................ <br /> Water Supply: Public system ❑ Community system ❑ PrivateN] 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: IIf yes,date-------------------1 No ® New Construction: Yes ;} No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) <br /> Septic Tank: Distance,from nearest well_��"`.Distance from foundation___ n____._____..Material--(,---- ........................... <br /> ` Q� frNo. of compkim_ ents______3�.__.__ __-Liquid depth=_...,�--_{.___}-____,.....Capacity.-j4/ <br /> Disposal Field: Distance from nearest well_.S=_p--------Distance from foundation.._1_Q------------Distance to nearest lot lineae.............. <br /> 20 Number of lines__....1_____________________ Length of each line___gzC...___..___._....._..Width of trench.__'�X='__...__._______------_ <br /> Type of filter materia_._ _-___.Depth of filter material__-/_ _______________Total length_9----`..--.--•-.•--------•---_•---__-- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.......Distance to nearest lot line_______________-_ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth................................. <br /> Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material______.______________________________ <br /> ❑ Size: Diameter-----------------------------------Depth-----------------------------------------------------Liquid Capacity.--------------------------gals. <br /> Privy: Distance from nearest well____------------------------------------ _______Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> o <br /> Remlin an /or repairing'(describe <br /> ,��� 1 . ------. • <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 /> ordina s, State`iawsr,an 'rules nd regulations of the San Joaquin Local Health District. <br /> r _r� (Sign ------- - --- -- - 4----------------------------------------------------------•------------------------------------------------(Owner and/or Contractor} <br /> -------------------------------•-•-(Title)------------•-------------------------------------------- <br /> (Pl an, showin ize of lot, location of system in relation to wells, buildings,etc., can be.placed on:.reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 13Y,4A ' ------------------------------------------------------------- DATE... "_� ' <br /> REVIEWEDBY---------------------------------------------------------— ------- --- --------------------------------------- DATE----------------•--•---------------------------------------- <br /> _ ......... x.._.� <br /> Alterations and/or recommendations•___----- r�-. .'` ` ::.,z�:, : ._.._. --------------------------------------------------------------------------------- <br /> r - <br /> _ .. ...... ..: :�l .t.,,i •� -- �-- ----- <br /> �=`--7- ---------------��- x---------------- ._�__�lt�`_14.'� " <br /> - ------- -- ------ ---- -- - <br /> - - --------- <br /> - ........... <br /> ---•-•----•-----------------------------------------------------......--------- <br /> ^6 <br /> ------------------------------------------`----------------------------------------------------------------------------------- ---------I—........ <br /> FINAL INSPECTION BY:.___, -_-1_4 �.-----------------•---- Date----- -`� -"..�- ................................................... <br /> -- --- - - - <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 8.59 ZM 5-61 ATLAS <br />