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FOR OFFICE USE: <br />------------------ -------------------------------------- <br />--------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. j�_..s <br />--------------------------------------------------------- (Complete in Duplicate) Date Issued ---1� Z <br />--------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> G*�--.--- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS A713 LO <br /> ATION. .. � '.................. <br /> -•---•------................................ <br /> Owner's Name-----• i---�.L--•--. ... <br /> ...................•---.----- <br /> ,ry -------- <br /> Address........-_l.- .1............ _ ---......--- <br /> Contractor's Name.............. . ........... ............................. ---...•-------------•-------•---•--••--•....--•--•-----------.....---•-----_.. Phone................................... <br /> Installation will serve: Residena Apartment House E] Commercial C] Trailer Court E] Motel [3Other <br /> Number of living units: f-..... Number of bedrooms ..I... Number of baths ---I---- Lot size ....�_�(..74............................. <br /> Water Supply: Public system ❑ Community system* 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--------------------) N04 New Construction: YekA— <br /> No [:] FHA/VA: Yes E] No& <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ <br /> Se ti Tank: Distance from nearest we]/&?, t_C7..Disten from fo��up�d�tion....l� -..Mat ial_ �'i . <br /> No. of compartments....�Zl---------Size...f, ))O.X ..:Viquid depth_..._,. .............Capacity...... ....... <br /> Disp sal Field: Distance from nearest well--/1PlFQDistance from found tion^--.. ..< .........Distance to nearest lot1ino.�........... <br /> Number of lines...... .......... Length of each line._._ _. .......Width of trench... ........................... <br /> Type of filter material..657'1-Depth of filter material_]-- --------------Total length.-• -i---- -----...._....__.. <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--.- <br /> ..............Lining material..................................... <br /> ❑ -Size: Diameter......................................Depth------------------. ---.. ------------Liquid Capacity............................ <br /> - - - --- <br /> Privy: Distance from nearest well__.----_________________________________-------mstance from nearest building__-___-..._.._..__...._.................. <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):......................................................................................................................................................... <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, St tows, d rule�regulaflons of the San Joaquin Local Health District. <br /> ....... <br /> L.�.a .-------- - --- - ---------------------------------------- ------------------•-----•---..........Owner and/or Contractor <br /> (Signed) ( / 1 <br /> By:..................................................•----...---------- --•---------•------------•-••••-----•------•-----•--•---------(riitle)---------------------------------------..----------------------- <br /> (Plot plan, showing size of lot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------.-_------- - ----------------• DATE---- ------ ... <br /> .., <br /> REVIEWED BY--------••- . --------------- DATE-- '� .!/ <br /> BUILDINGPERMIT ISSUED............................................... _ ............. DATE............................................................. <br /> Alterations and/or recommendations:.----------- ------ ------. ------------------............................................................------ <br /> ....---•-•-•-----•.................•---•-------------------•••---------------------------•--...---•-------------•----------•-•--•---••-------•-•-------------•-----------•-•----••-----------•-•---••--•----..........---•--. <br /> -----------•-- ------ - --------------------------•----••-•-------•---•------•--�---•-----------------•••-•------------------...----------•---- <br /> FINAL INSPECTION BY:------ ... ----------------- Date.............. --- ...... ---% <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strut <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED,8-59 RM 5-61 ATLAS ` <br />