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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> ---------------- .------------- APPLICATION FOR SANITATION PERMIT 'Permit No. <br /> ------ (Complete in Duplicate) J / <br /> --------------------- ----- ----------- ---- Date Issued -----......-".-� <br /> ----- -- This Permit Expires 1 Year From pate Issued ---- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei described. <br /> This epplication.is.made_in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_ <br /> Owner's Name Phone. <br /> - <br /> Address...................-+ 1+ �_ - <br /> Contractor's Names-------------------------------------------- _----__ Phone.............................. <br /> Installation will serve: Residence [10 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units; .1----- Number of bedrooms.'_-_----- Number of baths J_____ Lot size . " <br /> Water Supply: Public system' <br /> ❑ Community system ❑ Private ® Depth To Water Table 6L4_.- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 1&) Clay Loam ❑ Clay ❑ Adobe[4 Hardpan ❑ <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 sewer is available within 200 feet.) r <br /> Septic Tank: Distance from nearest well/ -------Distance from foundation_1_A....... Material..,-- ----- ' <br /> t <br /> No, of compartments__ ,/:-------------------Size_ •! f rx,-----------..Liquid depth__.s--------------- Capacitylr?-ll°___•-•-••-- `� <br /> Disposal Field: Distance from nearest well__/_t' __.-_Distance from foundation/0'.............Distance to nearest lot line_&... <br /> 19 Number of lines----11..___---•-----p------- Length of each line--------I.'tf_V--_--_------•.Width of trench.&`/------------------------ <br /> Type of filter materi �I�r+ _-----Depth of filter materiaL_._19-------------Total length / ------ <br /> Pit.. Distance to nearest wellf_�------------Distance from foundation...�l_t)'__._.__-.Distance to nearest lot line--47-_.__.__. _ <br /> Number of pits___:R"_------------- material _-______..__?_-----Size: Diameter__> _6 '__�r_'._...Depth---4 _'.__.____ <br /> ------------ <br /> Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material------------------------------------- <br /> ❑ Size: Diameter. Depth--- -----------• ------- i ----- € Liquid Capacity--- ------........gals. <br /> y F <br /> Privy: Distance from nearest well-----_____________.____._---_.__�►-_-.- .__Distance from nearest building_.-.__.________________•--___________--_ <br /> ❑ Distance to nearest lot line____________________________ <br /> --------------------------------------------*---------------- <br /> Remodeling <br /> ---------------------------•---------------•--------------- <br /> It r4,4 <br /> Remodeling and/or repairing (describe): ` <br /> ----------------••------------------ - <br /> -1------------------------------------------------------------------------------------------------- --------------------------------------•---••-----------------••-----------------•------------------------------ <br /> hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State' ws, an rules a regu Ion of the San Joaquin Local Health District. # <br /> (Signed) `"~ (Owner and/or Contractor) <br /> 9 - --a--------- ----- <br /> By:---------------------------------------------------------=----------------- ----- - -••-•----------------------••------- Title <br /> (Plot pla , 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 B ----------------------•-- <br /> REVIEWEDBY ----------------------- ----------------------------------------------------------- DATE--------------------•-- <br /> UILDING PERMIT-ISSUD-------•--•------------------------------------------------------------------•-• ------------ DATEAlteratons E <br /> and/or recommendations______________________.__.____--_--_________________-- <br /> ­-------------------------------- <br /> -•-- <br /> - ­­-------------------------------•----------•--.----- <br /> - <br /> --- ----- <br /> 41 <br /> ----------------- ---- ----------------------------• ------------------------•--•-----------------••----------------•-• ._.... <br /> I --------------------------------------------•------------------------------------------------- ----------------------------------------- <br /> -- - ------------------------------ <br /> FINAL INSPECTION BY:-- _- -------------------------- Date..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Stud 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED 8-59 2M 5.62 ATLAS <br /> - _ i <br />