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FOR OFFICE U E:J <br /> --------- - -- --- <br /> ------ -�l__.--.-._/ ( APPLICATION FOR SANITATION PERMIT Permit No. <br /> • i <br /> ---------r�------- ---- --- -- <br /> -f ----fir (Complete in Duplicate) <br /> ------------------=--- Date Issued --- !_ �f <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 ¢�r, <br /> r <br /> f <br /> • --,-z �f3N7'�P JOB ADDRESS AND L� <br /> Owners Name-------------------- ° <br /> -------------- <br /> ------ ----•--- ---------- Phone.----•--f ///-OS <br /> Address-----•---------------- it . <br /> ---------------------••---•--- -•----- -----------­----------------------------......... ---- <br /> Contractor's Name ---- -. ..-.A?.. _v5 - ....wa—,---------------------------------------------------------- -------- Phone <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ( Trailer Court ❑ Motel ❑ . Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -- <br /> Water Supply: stem €. <br /> PP Y= Publicsystem <br /> ,K Community system ❑ Private ❑ Depth to Water Table 45-0- ft ` <br /> Character of soil to a depth of 3 feet: Sand ❑-.' Gravel ❑ Sandy.Loam ❑ Clay Loam❑ .Clay ❑ AdobeX Hardpan [] <br /> Previous Application Made: (If yes,date---------------- --- No)K_ New Construction: Yes,0 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.) <br /> Septic Tank: Distance from nearest well--S--"--------Distance from o n�ati-rk&-r__.' Meterial_��Qct��✓-1� 4�----•----------------- <br /> -Liquid of com artments------- • ----------------Size-- ©- _ �t <br /> IQ , 7q « quid depth-- = Capacity...Zone ----- <br /> Disposal Field: Distance from nearest well---/Ul-VC..Distance from foundation--Z-p_`•_.'--Distance to nearest lot line-- _-_--. <br /> �' <br /> Number of lines_-_, _.__.rl_ <br /> ------Length of each line---�E_----- '�-----._-Width of trench____, <br /> Type of filter material.___ :.Depth of filter material-_---------------------Total length----------3 ______________- <br /> Seepage Pit: Dis#ante to nearest well----------------------Distance from foundatio--.---.----._'-_--.Distance to nearest lot line----------------- <br /> ElNumber of pits- ---4--------------Lining material,-----------------------Sloe: Diameter------------------------Depth------------------------ <br /> Cesspool: Distance from nearest well----------------.Distance from foundation-------------------- material,-..----.--.--- <br /> 9 ,-Y � 1 r. Y ----------•--- <br /> ❑ Size: Diameter--- ;Depth------------------ ---------------------------Liquid Capacity----------------------------gals. .. <br /> Privy:x Distance from nearest well.-__------.Y-------------- ----------_----------Distance from nearest building----: <br /> ., g = ------------------------- <br /> ❑ Distance to nearest lot line----- <br /> --_--__--:x! _ <br /> ---------•---- <br /> ----------------- <br /> Remodeling and/or repairing (describe){:---_-.�i � <br /> ---------•---------------------------------------•-- ' <br /> ------ <br /> `--"-'-------'------`------------k----- ------------` `-----`------`------" ------•-'-----------------•---------------------------------------------------------------------------------------------- ----------- <br /> 1 Hereby certify that ave repared this application and that the work will be done in'accocdance with San Joaquin County C <br /> ordinances, State laws, a d ru and regul ions of the San Joaquin Local Health District. <br /> (Signed)--------- --------------- ---- - --------- rfi <br /> (Owner and/or Contractor) <br /> - --------------------(Title)----- <br /> (Plot plan, showing size of to , location of system in relys, buildings, etc., can be�placm on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- y,.__-- -- ---- ------ ------------------- ------- <br /> --- ------------ DATE-----$'`--�--�=--""---�--�----- - <br /> ----------- <br /> EVIEWED BY------------------------------------------- ------------------------------------------ ----------------------. DATE - <br /> UILDING PERMIT ISSUED-----.------.._r-------------------------------------------- ., <br /> Alterations and/or recorpmen ations:- �� A` A <br /> ----- -----------••-------------- <br /> f . <br /> -E.r�------� - - - -f-----• �E_�(.-- -�-------l-------- -- -- -- -- Y L.% <br /> �---- i t-----•' - -- -- r--- ----i'-e-- •-•-=--- <br /> r �./ sJl <br /> i --ak-. 7�---- -------------------------- <br /> ----- -- r 0.-r_-/` -, - - c <br /> ----- ---- Q V <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 Street <br /> Stockton,California Lodf,California Manteca,California Tracy,California <br /> ES-9 REVISED 6-59 P.P.00.2M 6.60 <br />