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__, R OFFICE USE: . .. � .M <br /> -------------------------- <br /> APPLICATION <br /> Permit No. ... c <br /> APPLICATION FOR SANITATION PERMIT 1 G� <br /> ------- -------------:.-------- -------------- (Complete in'Duplicate) <br /> - This Permit Expires 1 Year From Date Issued Date Issued _______: <br /> Application is hereby made to the San Joaquin Local Health Disfir ct for a-permit to construct and install the work herein described. <br /> This application,is made..in compliance with County Ordinance No". 549.'x` ' <br /> j j2p D S I4(c�e,�C,,F-1 L/ .� <br /> JOB ADDRESS AND LOCATION---J-_:.[e-. _ "A- --------------*nf°li............ -----------------------1.9--T----- �p^Z <br /> Owner's Name---- ----------fi r 11�------------------------------------------------- ------------------------------- ------------- Phone--------------------_-- <br /> Address----•-------------------- -- .- ----------------------------------- <br /> Confiractor's Name_ _.. (1-� -- "`"- ------------ <br /> t <br /> ""^y' <br /> Installation will serve: Reside ce Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> y Number of living units: Number of bedrooms -14--- Number of baths --e-- Lot size -_._� _.._ _` _d----------------- ! <br /> Water Supply: Public system E] Community sy em �rivate E] Depth to Water Table ---------ft. <br /> Character of soil to a depth of 3 feet: Sand [Gravel ❑ S y Loam T❑- Clay Loam Ciay� Adobe ❑ Hardpan ❑ <br /> Previous Application Made:I1 (If yes,date------ -----------) No New Construction: Yes �N FHA/VA: Yes E] No / <br /> TYPE OF INSTALLATION IAND SPECIFICATIONS: - , <br /> (N septic tank or cesspool permitted if public sewer is available within 200 feet.) -� <br /> 1 1 <br /> Septic ank: Distance from nearest well--1_J_ ___ Distant from foundation-_/V------ Ca acct O <br /> Material_ Q,�I- _ _ <br /> y ��f No. of compartments---_-----,� .-----Size__WC__ _J_Q_ .......Liquid depth_._ p Y C T/ <br /> ,____u. _. .r t <br /> Dispos ie#d: Distance from nearest well_____;._ ..__`_Distance from found�ti n...... ............`Distance to nearest lo`line-...-_-.91__.______ <br /> Number of lines-- --- ---_. ------ --Length Length of each linty_/�iY X__:7M.W"idth of french.-. ._. ' <br /> '? I <br /> ----..Total len th------- ------------------------- <br /> Type of filter material_y��.��C'�Depth of filter material____-_��-__ g � n <br /> Seepage Pit: Distance to.nearest well__----- --------Distance from foundation___-____.__..-.___.Distance to nearest lot line-_--_.-.--.._---_ <br /> ❑ Number ofpits-------:--------------Lining material-----------------------Size: Diameter--------:------- -_--Depth-.------------------------------- <br /> Cesspool: Disfance from nearest well-----------------Distance from founclation--_----------------Lining material--------------- _-----_---_--_ <br /> Size: Diameter--------------------------------------De th------------- -----------------------------------.-Li quid Capacity gals. <br /> I <br /> Privy: Distance from nearest well_=-------------"--------------------------------Distance from nearest building---------------------------------------- <br /> ❑ Distance to nearest-lof_Line--------------- ------------------------------------------- ---------------------- --- ---------------- -------------------- --------------- <br /> Remodeling and/or repairing (describe)r ----------- r `` <br /> ---------•-------------------•-------•---------------- ------------'-------------------------------------•------------------------------------------------------------------------------------------------------------ <br /> r <br /> ' — -- – = <br /> -- i - ------------- --- <br /> ---------------------------------­­-----------•------------------------------------------------------------------------- ------ -------------------------------------------------------- <br /> I hereby certify tha 'I have iprepared this application and that the work will be`done in a crdance with San Joaquin County <br /> ordinances, State I s, d rules, regulations of.,the San Joaquin Local Health District. U <br /> (Signed)- -------- G' --------------------------------- -------- ----------------------------------------------(Ow and/or Contractor) <br /> B . [ 1 ' <br /> --------------- -- - ------------------ y ± ' '� _ Title_ <br /> (Owner <br /> (Plot plan, showing of lot, location of ystern in relation to wells, buildings, etc., can "bpl a on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- --------------------------------------------------�k-5------------------------------- DATE-•------------9-16 --1 <br /> REVIEWED BY--------------------- - --------- -------- - ----------- :,-_ =-T__::_-:-- <br /> DATE, - <br /> BUILDINGPERMIT ISSUED----------------------------------------------- I - _ �__:---------`-..DATE--------------------------------------------- --------------- <br /> "� <br /> Alterations and/or recommendations:._........................ <br /> --- . •- ------------------------- ----- ----- <br /> ---------------------------------- -------------------------------- =-•-•----------------------- ----------------------------------------------------------------- ----------------------------------------------------- <br /> FINAL INSPECTION BY:.. --------- --- =5 Date ..L ---------------------------------- <br /> 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-•63 Ir-P.M ! <br /> 4� <br />