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FOR OFFICE USE; <br /> ­_,------------------- -------------------------- <br />----------- -------------------------------------------- APPLICATION FOR'SANITATION PERMIT Permit No. .... .................. <br /> ------------- (Complete in Duplicate) <br /> Date Issued ._____/__;!__ _._ <br /> - ---- - -------- --------- This Permit Expires I Year From Date Issued a <br /> --------------------- ------------------ <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 /> --- --------- - -- ---- <br /> JOB ADDRESS AND CATS N---- - -- -Is _ ---- ---- <br /> - ----- ----- --------------------------- <br /> Owner's Name---------yl� __5D <br /> ----------------- --------------------------------------------- Phone---•----------' J <br /> Address--------------- • 6", <br /> ----------------------- ------------- -------------------------------------•--1--------.- -----------------------.............. <br /> Contr ctor's <br /> l <br /> L =V-Z�Installation wilserve: Residence Apartment House 0 Commercial E] Trailer Court Mofel El. Other E] <br /> Number of living units:. Number of bedrooms _-2-INumber of baths Lot size -- <br /> --- --- <br /> Water' Supply: Public system E]. Community system El PrivateDepth to Water Table <br /> )� /Z�i� ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam E] Clay LoamClay [-] Adobe[-] Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No New Construction: Yes FN <br /> o E] FHA/VA:-Yes ❑ No <br />-�z;rT-YPE,OFiINSTALLATION,AND-SPECIFICATIONS:�� <br /> 4 <br /> (No septic f ank'or-cesspool permitted if public sewer is available wi+hin'200 feet.) <br /> Se Tank: D;sfance from nea'�esf ----Distance from foundation-----—-----------Mat I <br /> r1_ ------------------------------- ...... <br /> Nc�. of compartments-----_ 2,11---------- ---Liquid depth__-_----- <br /> PN ... <br /> Disposal Field: Distance from nearest well.....70------Distance from foundation------ Distance to nearest lot IinQ__<_0_ <br /> ---------- <br /> Nu1mber of �ines._'_'I'--) -------------------Length of each fine________r ----------j_Width of trench___,A._J�f--------------- <br /> Type of filter.rnaieirila 1.5 -Depth of filter nterial-___/_9__r'_ -Total "length-------L:k1lei7 <br /> mc ----- <br /> -------------------------------- <br /> Seepage Pit- Distance to nearest well------------------------Distance from foundaiion-----------........Distance to nearest lot line----------------- <br /> F] Number of-pits---- --------------Lining material a-------------------Size: Diameter-----------------------Depth__.-_----._-__-___ 1---------- <br /> Cesspool: Distance from nearest well__-__.___-_.-- :Distance'-from foundation------------- ......Lining material--.._--____---.._--_-_..--_____.__. <br /> ❑ Size: <br /> aterial---------------------- --------- <br /> Size: Diameter------I I ------------------------------Depth- f ------------------------------------------Liquid Capacity----------------- ----------gals. <br /> " Privy: "Y "P"Distance"frosYi..nearest well:- <br /> ----------------------------------- --Distance from.`I�fance frnearM'building__ <br /> F1 Distance to nearest lot line------7--------7-------- ---------------- 0 <br /> Remodeling and/or repairing (descr`ible'):---------------0-------------------- --------------------------------- -------------- -------------------------------------------------------- <br /> .,I k #,%Wt I <br /> ---------------------------------------------------------------�:--------------------------------------------------------- --------- <br /> sw *1-------------------------------------------------------------------------------- <br /> ----------------------------------------------------------- ---t <br /> --------------------------------------------------------- ---------I---------------------------------- ---------------------------- ------------------- <br /> ------------------------------------ ----------------------------------------------------------------------m--- <br /> --­------------------------------------------------------------------------------------:--------------------- <br /> I he ebYe fif that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, stc 71-S, and rules a d" -ulati s of the San Joaquin Local Health District, <br /> !dre <br /> ------a--.A----- - ------- -------------------------------------------------------------------- --- -------(Owner and/or Contracforl <br /> (Signed)- <br /> By:... <br /> ----------------------------- --------- --------------- -----------------------------------------------------(Title)------- ------------ <br /> ----------- ------- ------ - --------------------- <br /> A ­f�r— _u <br /> of <br /> Ula", raf7on of system in rela ian wells7b -ildi4s <br /> (POi—plan,showing-siie­cfIa,­l <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY----------- ------- -------- ---- - ---------- -------- ------------------------------------- DATE------------------------- ------------------------------- <br /> REVIEWEDBY----------------------------------------- ----------------------- --------- -- ---- - -- ---- ----------------------- DATE------ <br /> BUILDING PERMIT ISSUED----------------- -------- <br /> ------- ----------1- DATE--------- ------------- <br /> Alferafions and/or recommendations:--------- ------ - ............... k� <br /> ------------------------ - ---------------------k -------------------------------------I--------------------------------------------------:--------------------------------------- <br /> --------------- --- --------------- -------------------------­_.��-------------------------------------------------- ------------------------------------------------ <br /> ---------------------I------------------------------------------i-----------------------------7-------------- ------------------------------------------------------I-------------------------------------------- <br /> --------------------- --------- -------- ---- ------------------------------------------------------w------------------------Z-1------------------------------------------------------------------------------ <br /> ---------------- ---- <br /> ----- ------------------ - <br /> - ---------------------- <br /> ------------------------- - - ------------- <br /> FINAL INSPECTION BY___________ -3 ' - ---- <br /> ------------------------------------------------ <br /> ------------ --------------- -------- ---- <br /> ---------­----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodir California Manteca,California Tracy,California <br /> ES 9 REVISED 13-59 3M 3-63 F.P,CL3. <br />