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FOR OFFICE USE: <br /> ------------------------------------------------------- _I ,- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .................. <br /> -------------------- ----------------------------- (Complete in Duplicate) f <br /> Date Issued <br />---------------------------------------------............. This Permit Expires 1 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 Ordinan a No. 549. <br /> �L c <br /> JOB ADDRESS AND LOCATION_.`. ._ 3® � ._... ......................... ��-- <br /> ------ ...---- -----._... ----•••- <br /> Owner's Name (5� <br /> P one•-- <br /> U <br /> Address 2.7. r l -- =---------- <br /> Contractor's Name..........=................................................................................................................................... Phone....................... <br /> ............ <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3Number of living units: _...... Number of bedrooms -AA Number of baths ----L. Lot size _�_�....x...�rr�LL�a........................ <br /> Water Supply: Public system ❑ Community system JN 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--------------- ----) NoIVNew Construction: YesA No ❑ FHA/VA: Yes ❑ Now <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank: Distance from nearest well__ .-f Distanc e from foundation-_---/.0.-----_.Material.... ........... .. ...... .....____.._. <br /> P9 No. of compartments-----"�_______________Size_ XI _ .jam:___Liquid de''p//h__Y%/ ------------Capacity.,4?o,r1_.a......_ r-) <br /> Disposal Field: Distance from nearest well„$rr Q_t_Distance fr m fo datiyy��n__._ T' Distance to nearest lot I-ne,,-,6----_- v" <br /> 1- 2 .�2- %if^'I <br /> Number of lines.7--------------- _____ _ Le g inT each Iln�___-__---.-__ Width of trench._._ . _.._......._..._._ <br /> Type of filter material.J ___._.-_ ._.Depth of filter material....lg --------Total length......14..!;;�...................... <br /> Seepage Pit: , Distance to nearest well---------------------_Distance from foundation....................Distance to nearest lot line................. 0 <br /> r-1Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Depth................................. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..................................... <br /> ❑ Size: Diameter------------------------ -----.Depth----•---------------------------•-------------------Liquid Capacity............................ <br /> Privy: Distance from nearest well------_---------------------------------- -------Distance from nearest building---------------------------------........... <br /> ❑ Distance to nearest lot line------ ------------------------------------------•------•------------------------------•-----------------•------•-----•---------...-•-------- <br /> Remodeling and/or repairing (describe):-----------------------------------------------------------------------------------------------......................................................... <br /> --------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------•--•------------------------------- <br /> --------------------•------------------------------------------•------------------------•--------------•---••--••••-------•---•-------•-------------••••-•---------------•-•••-----------•--•-••••......••---••-•••----------- <br /> ----------------------•----- -----------------------------•----------------------------------------------------------------------•------•----•------------• .......................................................... <br /> I hereb ert- y that prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances to �aws ul regulations of the San Joaquin Local Health District. <br /> (Si n ---------------- � ------------------- -------------------------------------------------------------- --------------(Owner and/or Contractor) <br /> By:---------------------------------------------------------------------------------------------------------------------------- -------(Title)--------------------------------- <br /> (Piot plan, showing size 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 BY--------------------------- -------- ----------- ------ ----------•----------------------- DATE------------------------------------------------------------ <br /> REVIEWED BY--------------------------------------------------------------------------- . DATE-------- <br /> ----------------------- <br /> BUILDING PERMIT ISSUED ----_. DATE............................ � � <br /> ---- ---•-... . <br /> Alterations and/or recommendations: -------------------------------------------------------------------------------•------------------------ ..........---- <br /> ---------•----•....-----•----...---•-----------------------•-----•---. --------------------------------------------------•--•----•--•--•----------••-•---------------.----------•-------•--•-------•••-•-•----••----------•- <br /> -------•------•-----------------------•----------------------------------- ------------------------ -------------------------------•••••---•--•--•••-•••-•-••-••--•--••----------------...--•-----•--••----------••--- <br /> -------------•----------------------------------------- ----------------------------------------- ---------------- ------------------------......-•-----•---•---------_...•••----------•----•----------•--.-•--- <br /> ------------------------------------ ...... -------------------- -- ---- --- <br /> FINALINSPECTION BY--------- --- ---------------------------- --------------------- Date.......................6`.................................................... <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,Califesiels Tracy,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS ^► � i <br />