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rUKUrrttt Uat: <br /> ---------------- ------ ----- - ----------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .... .......5 <br /> ----------------------------- --------------------------- (Complete in Duplicate) �� <br /> _-.-._._ This Permit Expires 1 Year From Date Issued Date Issued ... ......�L..:...�� <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 /> JOB ADDRESS AND LOCATION 11 ..FJ_ <br /> F6 4 <br /> Owner's Name----------- <br /> ------------------------------------------ Phone---------------------- <br /> q ; � ------- <br /> Addressd.............. ............. <br /> Contractor's Name................................... --------- Phone................................... <br /> Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ <br /> Number of living units: Number of bedrooms ___Y Number of baths -1..... Lot size . c__ <br /> Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table ft. • <br /> Character of soil to'a depth of 3 feet: Sand C] Gravel [-] Sandy oam ❑ Clay Loam ❑ Clay ❑ tdob GAKHardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No [ New Construction: Yes�No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sews ' available within 200 feet.) <br /> Se tic Tank: Distance from nearest well Te_.. I tante fr foun fion___�_ I ......-_.M��r+er ai_______ ______ <br /> No. of compartments_______.'� __.____Size_,'3�(. x ,__•Liquid depth_____`r_ -----Capacity_-._�_� Q..-.. <br /> Disposal Field: Distance from nearest weI117'.*�_Distance from foundation._._ <br /> ry -L.......Distance to nearest lot <br /> Number of lines------- ...�___._-____ _Length of each line,... Width of trench._... ._____________________ <br /> �T---- - <br /> Type of filter material...6_-Ir _ _.____ _4Depth of filter material.../?_____________Total length------- . <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 /> El Size: Diameter--------------------------------------Depth-------------------------------------------------- Liquid Capacity--------------•----........gal s. <br /> Privy: Distance from nearest well_________________________________________ _"____-Distance from nearest building-_-_________________--._-..______________. <br /> ❑ Distance to nearest lot line.------------------------------------------- -•-----------`-------------•---••-------------�-- <br /> 4 z9 <br /> Remodeling and/or repairing (describe):_ !��__ ,C h+- : !..__ ,,.ead...!lS�-cam ., ��C-...... <br /> -------------------------------------------------•------------------------------•••--------.--------------------.....---------------••-•-•--------------•-----------------•-•--------------- -------- <br /> --•----------------------------------- -­----------­----------- ----------------------------------._..--------•---•------------------------•-------------•--...------•---•---•-••----------------- <br /> I hereby certify tha+ 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 /> (Signed). .......... _ --------------------------------------------•---••-------------------(Owner and/or Contractorl <br /> By: -•----------------------------------..............(Title)-------.---------------------------------_-------------------- <br /> (Plot 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 /> REVIEWEDBY---------------------------------•--•-------------------------------------------------------------------•------------------ DATE----- <br /> BUILDING PERMIT ISSUED............------------------------------------ -------------- DATE----- <br /> Alterations and/or recommendations: 44 <br /> --------------------------•--•---•-•------------------•----..-......---•-----••------•-•-----...----------•--------•-----... <br /> FINAL INSPECTION BY:.. ---------------------• Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Svreet 124 Sycamore Street 205 west 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California' <br /> ES 9 REVISED 5-59 pM 5-61 ATLAS <br />