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OFFICE bE:, -ZI g I <br />.................. <br /> ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. .._.�`�.'.��z <br />--------------------•------------------- --------------- (Complete in Duplicate) y/ <br /> -- --- ` This Permit Expires''! Year From Date Issued Date Issued -f. <br /> Applicafion is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliancetwith County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATI N•_..3c/ <br /> R.eiYh �•---•---•--••-------------- --------••-------..__....------ ----------------------•-------...:---•--•---- <br /> Owner's Name-----------0..... ----------------------------------------------------------•----- •----------•--- Phone.................................... <br /> Address --------------•---•-----•--•---•-• ------------••...................................................... <br /> Contractor's Name------ --.. ............. ----....----------------------------•----....-.-..----••--•---------•........................ Phone................................... <br /> Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: ._-: .. Number of bedrooms ---. Number of baths _ !� <br /> � � �•--- Lot size -------61 <br /> Supply: Public system. E✓]Community system ❑ Private ❑ Depth to Water Table jo(e_ ft. <br /> Character of soil.to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ffH rdpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes, V�'No ❑ FHA/VA: Yes ❑ No Ek-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer 1s available within 200 feet.) <br /> Septi .Tank. '� Distance from nearest well-----------------Distance from foundation.-----------.-------Material_------__---_-................................... <br /> No. of compartments--------------------------Size...............-----------------Liquid depth--------------------------Capacity--............••-•�-- <br /> Disposal Field:/ Distance from nearest well. (_...-.Distance from foundation--YP..---._.....Distance to nearest lot line--_zb <br /> Number of lines.---___._...1._ -_-----_ -- Length of each line---------5.Q-------------Width of trench.-t-91.",_ ................... . <br /> Type of filter mateial P�---------Depth of filter material...-._!_X- ........ length--------- --— ------- <br /> Type rr <br /> W <br /> Seepage Pit: Distance to nearest well-- ,,�------Distance f m fo ndation-.�{4......_...Distance to nearest lot line__-a..-.._ <br /> Number of pits__..-_I------------Lining materia _4 --.Siie: Diameter_, Depth-------.-- . ............ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material•--------_.._--.------------__-_----- <br /> ❑ Size: Diameter------- -----------------------------Depth-•--------------------------------------------------Liquid Capacity----------------------------gals* <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----_---_--_-------..--.-.-__----.---.---. <br /> ❑ Distance to nearest lot line------------------------------------------------•------------------•------•---------------•-------------.... <br /> } <br /> Remodelingand/or repairing (describe):-------------------------------------- ----.......••----••------•---•--•-••••-••---.....-••--...-•-•--•-----••-••---•...-•-...__.••...-•-•-----•---.._.._ <br /> I <br /> --------------------•---...._-------------------------------- ------------------------------------ -----------------------------------------------------------------------------------.---------- <br /> 1 <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 laws, and rules and �gulations of he an Joaquin Local Health District. <br /> 7 <br /> (Signed)..................................................... ---------- ----•- -- --------------------------------------------------------------(Owner and/or Contractor) <br /> By= ----------------------------------------- --- -••-•------- -----------------------------------------------(Title)------------------------------------ --------- --------------- <br /> (Plot plan. showing site of lot, location of s s em n relation to wells, buildings, etc., can be placed on reverse side). <br /> # FOR DEPARTMENT USE ONLY r� <br /> APPLICATION ACCEPTED BY-- - ---- ------- - - --------------------- --------------------------------------- DATE_.-_w� <br /> REVIEWEDBY-------------------------------------- ----------••--------------------------------------------------•• •---••-•---------._ DATE------_---_------..--.. <br /> BUILDING PERMIT ISSUED-------------_---- ----------------------------•----------------------•-------------•--------------- DATE------------_------••----- <br /> Alterations and/or a ommendattiags':-•--------------------- --------------------- - - ------•.•f 4 _..... <br /> ....................----------------------------------------------------------------------------------- --•---------------------------------•--•----•--• ---------------------------------- <br /> ------------------------­--- <br /> • • - <br /> FINAL}. INSPECTION BY:.--�r. •-----. Date a- �� _-&__1-------- -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strut , 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> £s 4 R£V,s E9 8-59 SM 6-6[ ATLAS <br />