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FOR OFFICE USE: <br />------- ------------------------------------------------- f <br />____________________________________________ ____________ APPLICATION FOR SANITATION PERMIT Permit No, <br />-------------- ---------------------------------------- (Complete in Duplicate) 2 - <br /> _ - crate Issued -��=--------------9 <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. <br /> JOB ADDRESS AND LOCATION-----�e_v. -----/ , ,t2 . <br /> ' .----- 1-:--- __. _._ 1QC? ._..--- C'---•---------------- <br /> Owner's Name .ffW, 71 5 -----�---------------•-------- ••------------------ Phone_sr_?_?__?. <br /> Address....... ------�- ._&Zoo <br /> Contractor's Name------ ..--• �67----------•-------••----------•-•------•---••----------------------- Phone.J7cR 3//aW�>_ <br /> v— d <br /> Installation will serve: Residence [I Apartment House [-] Commercial [3 Trailer Court ❑ Motel ❑ Other_Q- <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------------------....................­*............... <br /> Water Supply: Public system ❑ Community system ❑ Private,0" Depth to Water Table .-.--..- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date....................) No.O' New Construction: Yes ❑ 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-___ Q._..Distance from foundation--------------------Material-----_..------------------------------ <br /> 11i' No. of compartments------- i---- --------------Size-----1-9,OV...---....Liquid depth_...----.•--.-------____--Capacify_--/C�-------- � <br /> Disposal Field: Distance from nearest well---(a//_d---..._Distance from foundation-----___________.Distance to nearest lot line................ <br /> Number of lines_____________ Len y� eZ <br /> I�_ - -------Length of each line--------- -----------��-----.Width of trench--- f----- 1�----�f 2 1 <br /> Type of filter material- /,9_____4_• -Depth of filter material--- ._. ____------Total length____ ___________________________ <br /> Seepage Pit: Distance to nearest well_____-______________Distance from foundation__________________..Distance to nearest lot line.........._--.... (,d <br /> ❑ Number of P ---------------Lining material-----------------------Size: Diameter-------------------------Depth--------------------------------- t� <br /> CessCesspool: Distance fr m}snear j `� \ <br /> p est well________.___..__Dlstance from foundation____________________Lining ma#erial..__._________._____..__..__.___.___. <br /> ❑ Size: Diameter----------- _ -------------•-Depth--------------------------- ------Liquid Capacity------•----•-------------•-gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------____________________.__..____._. <br /> ❑ Distance to nearest lot line----- -----•--------------------------------------------•-------------------------------------------------•--------•••••--•----•--•-------- <br /> Remodelingand/or repairing (describe)-------------------------------------------------------------------------•-•----•------------------------------------------_n------•---•••------••--- k <br /> ----------- ----••----•-------------------•--------------- ---•------. --•- ----------------------------------------------------------------•-------------------------•--------------------------------•-------- <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 regulations of the San Joaquin Local Health District. <br /> (Signed} ... -------------------------------------------------------(Owner and/or Contractor) <br /> By:--------------------------------- ---•--•--•-------------•--------------------------------------------------------------------(Title)--------------------------------------- -- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ c ----------------------- DATE--------r� �� r rj ------------------ I <br /> REVIEWEDBY -------------- :--------•-•- DATE------ ------ .--------------------------------------------- <br /> --------- <br /> BUILDING PERMIT ISSUED----------------------- - ,4TE------------ <br /> i--------- <br /> Alterations and/or recommendations:.--_-•_-- -_fG-- --- -- -------- t- -•----f/�C --•-•-• •-j ----•-----AV' --1-f <br /> ---•----.-.-----•----..----•-- ------------------------•---•-------------- -- ----------------------------------------------------------------•------•----------___---------•-------------------•------•-------•------------ f <br /> ------------------------•------ - ........ ------ ------------•----------------- ----__.--•---------------------------------------------------------------------------------•---------------------------------------- <br /> FINAL INSPECTION BY:-------- -------------- Date---------- <br /> _. --------..I___.. f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California \Tracy,California <br /> ES 9 REVISED 5-59 2M 5-62 ATLAS \ I <br />