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FOR OFFICE USI_^ <br /> -------------------------------- --------------- <br /> _______________________--______.___-______-___-.----__-_- APPLICATION FOR SANITATION PERMIT Permit No. <br /> - ---------------------- --------------------------------- (Complete in Duplicate) <br /> Date Issued <br /> -- <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 Ordinance No. 549. A i- <br /> JOB ADDRESS AND,LOCATION..__>6k _- � �G- _- <br /> r. ----- - ------------------•----�'-�.--- ` 1` <br /> Owner's Name----- � ---y .. �L ;G ._: Cael Phone_4---4-1'.s = r --- --- <br /> Address `5� '- ' <br /> Contractor's Name --`----------------------------•---- ------------- --------------------- <br /> Installation will serve: (fesidence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms JT.- Number of baths -_ __- Lot size -----I__- _6_- f- cam.-------------_-- <br /> Water. Supply: Publicsystem ❑ Community(system ❑ Private ;K . Depth to Water ±able,_rV ft. <br /> Character of soil to a depth of 3-fleet: Sand ❑ Gravel ❑ Sandy Loam E Clay Loam ❑ Clay ❑ Adobe(] Hardpan ❑ <br /> Previous Application Made (If yes,dote-----------__........). :No ❑ New Construction: Yes'D No ® FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r 'y3a V' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Cr <br /> Septic_-Tank:-._-_-.;=' Distance_fr_omrneare'st well----- :__-Distance„fiom.oundaton_.-� .-__-..M�ateTrials--------------------------------------- ----------- --- <br /> ❑ No, of compartments .__. ------------Size---------=-------- --------Liquid deph -------- -------- <br /> Capacity----------------------- <br /> Disposal <br /> ----- - -Disposal Field: Distance from nearest well...................Distance from foundation--------------------Distance to nearest lot line-__--___:_______ <br /> ❑ Number of lines--------------------- ------=-----Length of eachline------------------------------Width of french----------------------------------- <br /> .,. a. .,.YYPe of filter material--------------------k-----Depth of filter 'material---_----------_--------Total_,length----'----•---------------------•----__--- <br /> Seepage Pit: Distance to nearest well_ ------Distance-from-foundation___--/__d-U___.Distance.to nearest lot line___---r-------- <br /> Number-of pits-------I.-_ _l-Lining'mai areal:: : Diameter_. : -.i---_--_---Deptn-_` �Y____________________ <br /> Cesspool: Distance fromi,nearesf`well'___-_-_--___-'-Distance from foundation „.Lining material________________ '__.____-_. <br /> ❑ Size: Diameter-------------------------------------Depfh-------------- ---------------------------------4--Liquid Capacity--- -------------gals. i <br /> ? Priv Distance fromnearest well____________________ I------------ --Distance from nearest building ----_--_--. <br /> ❑ Distance to nearest lot line-------- ------------------------------------•--------------------- <br /> Remodelin and/or repairing descr' e �_-___ _ <br /> 9 / p g �1--- X21 - <br /> -- -------- <br /> ------------------- ----'---c- ------------------------------- <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, State ws, and rules 'and regulations of the San'Joaquin Local Health District. <br /> ----------- - = - <br /> ---------------------- ----------------------------- <br /> (Signed)__-_____ _ __r_� =_ . ----.(Owner and/or Contractor) <br /> B <br /> ---------------- -- --- <br /> (plot- Ian. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------I----f -r-- ------------------------------------------------------=--------- DATE---IeV -`` <br /> REVIEWEDBY--------------- ----------------'------------- -------------------- --------------------------------------•-------------•------ DATE------------------•--------- --- <br /> > BUILDING PERMIT ISSUED----------'-k------------------------------------------------------------------------------------- DATE-`.....I--------------------------- --------------------------- <br /> Alterations and/or recommendati no s: ---------------s--------------- ---------•-------------------------------------------------------•---------------•-------------------------•----------- <br /> r . <br /> _�' <br /> --------------------------- ---- ;------------ ----------------------------------------------•----­_1-------- ---------- ------------------------••-------------------------- <br /> -----------••---- ------ <br /> 1 <br /> ----------- ---------------- - ----- ---- - ----- --------------------------------------•-•------------•-----------•---------- ---•------- ------- <br /> 1, <br /> .. <br /> s <br /> a y. r.a <br /> FINAL INSPECTION BY:----... _ .-----_ - __... « Date__ --- <br /> I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> � Tracy,California <br /> ES 9 REVISED 6-59 3M 3-'63 F,R.QD. , <br /> i <br /> r” ' <br />