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0 # <br /> ` 1 ' APPLICATION FOR SANITATION PERMIT Permit No. .•,l-_�: ��:25 <br /> (Complete in Duplicate) � J <br /> - . Date <br /> This Permit Expires 1 Ybar From Date Issued <br /> Application is hereby grade to the San Joaquin Local Health District for a permit to construct and install the work herein descrab d. <br /> This application is made in compliance- with County Ordinance No. 549. <br /> 1 <br /> JOB ADDRESS AND CATION 1 `�= ° / - --------------------- ---------- <br /> Owner's Name-------- -------•--------- -- ----- - <br /> V --- ---------------- ------------------------------------------------------------------------------------- Phone_/ _ .----�5••---- <br /> Address = -1__ ...... --------------------------------------------------------------------------------- <br /> Contractor's Name------------- _ . Phone <br /> Installation will serve: Residence 2--A--partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms©7__ Number o aths __/_ Lot size ________ _____________ <br /> Water Supply: Public system ❑ Community system [_1 Pr Depth to Water Table 7J,- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 91--__`New Construction: Yes ❑ No 2'_'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 /> P i anl, Distance from nearest well_________________Distance from foundation-------------------.Material-_____.___________-________---__ <br /> No. of compartments------------------- ------Size------------------------•-------Liquid depth----------------- --------Capacity----------------------- <br /> spo 1�1: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Number of linesr-'--------------------------------Length of each line------------------------------Width of trench--------------------------------.-- I <br /> Type of filter material______________________ _Depth of filter material____________._____....Total length-------------------------------------- <br /> Seepage Pit: Distance to nearest Dista e to dation---��__------Distance to nearest lot line_, ___..._ <br /> Number of pits--- ____________Lining materiaSize: Diameter---- ----------- <br /> Depth__2_.S~_________________ <br /> # I <br /> Cesspool: Distance. from nearest well--------------___Distance from foundation--------------------Lining material-----------.------------------------- <br /> 171 <br /> ______ ______❑ Size: Diameter------------------ ------Depth----------------------------- ---------------------Liquid Capacity-- -------------------------gals. <br /> Privy: Distance from +Iarest_well________________________.____________________.Distance from nearest building------------------------------- <br /> ❑ Distance to nearest lot line---- ------------------------------ ---------- ------------------------------------•-------------------------------------------- <br /> �.s <br /> Remodelingand/or repairing (describe)------------------------------------------------------------------------------------------------- ---------------------------------------•---------------- <br /> ll . <br /> ------------------------------------------------------------ -I------------------------------------------------------------------------ ----------- <br /> --------------------------------------------------- ----------­------------------- --------------------------------------------------------------------------------------------------------------- --- � <br /> f <br /> ------------------------------------------------------- -•-•------------------------------------------•----------------------------•-------------------------- ---------------------•-- <br /> I here 4 at I have prepared this applica+ion and that the work will be done in accordance with San Joaquin County <br /> ordinanc s, Sta I and r les an gulations of the San Joaquin Local Health District. <br /> (Signed} ! ------- ------ ( wner and/or Contractor] <br /> By;--------------------------------------------c------ ------- -�r_e_afiion <br /> - ----- -- - -- ---------------(Ti+le} ------------------------ <br /> (Plot <br /> --------- --------..._...._ <br /> (Plot plan, showing size of lot, location of system iwells, uildings, etc., can be place on everse side). I <br /> .s <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- DATE-------- <br /> REVIEWED BY----------------------------------- =------ fie DATE <br /> BUILDING PERMIT ISSUED----------------`------------------------------------- <br /> ---------------------------------------------- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations ---------------- - --------- ------------------/------------ -----------------------------------•-------------------------•---------------•-------------- <br /> ------------------------------------- --------------- 1-r----P-r-T. .-14---- -- �5 ------...0 __------------— ---- <br /> t <br /> --- = - - - <br /> --- -- ---- - <br /> ----- ------- - ------- ------ - ------------------- - .. ---- - -------- <br /> --- -- <br /> -~-�- <br /> FINALINSPL-..-Er -- - - - -- - ---- - -- ------ - -- ---- Dete------------ - --------------------------- ------------- <br /> SAN <br /> - ----------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Sou6 American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California a Lodi, California Manteca, California Tracy, California +, <br /> FS-9-2M Revised S-'59 F.P.Co. <br />