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FOR OFFICE USE: �,,- t•. <br />--------------- Permit No. .._�..`.�.•�....�.0 <br /> ------------------ - <br /> ---------- APPLICATION FOR SANITATION PERMIT <br /> ----------------------------- (Complete in Duplicate) Date Issued ---_--------­------- <br /> L <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 /> *3 i8' . <br /> JOB ADDRESS A D LOCATION----------._ ----------•------ <br /> Owner's Name. --• Phone---------••--•------••----•-------. <br /> • -•-------------------------- <br /> aa v' ----------------------••---------•----- ------------------- •--- <br /> Address--••--...... ------------ - ------ rte' <br /> Contractor's Name..---• a� - --------------------- <br /> ---•--•-- Phone.............�--�..ti�l <br /> Installation will serve: Residence [Y—Apartment House [� Commercial ❑ Trailer Court ❑ Motel ❑ Other [I�1 - �-`-�`--`-�---Y ---------------- <br /> �=-f� - ••---�- <br /> Number of living units: ___P.___ Number of bedrooms _____-__ Number of-baths __�--- Lot size --- <br /> Water Supply: Public system at-1'_*o�muriity system ❑ Private• Depth To Water Table J4'Ir�. ft. <br /> Character of soil to a depth of 3 feet:! Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe l—_Nn ❑ ` <br /> Application Made: (If yes,date______ _______ ___) No New Construction: Yes �No ❑ FHA/VA: Yes �No ❑ i <br /> Previous App � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> I r <br /> Septi Tank- Distance from nearest well�?',''�Distance from foundation__/p..____.___.Ma}eria........... <br /> _____�________________________________________ t <br /> -XS -Li utd de fih--------�.---- -- --- Capacity.. a <br /> No. of compartments--____------_____-____Size___.... q r p• <br /> Disposal Field: Distance from neaI est well ----__Distance from foundation._4.�t__.......... <br /> Distance to nearest lot line_--------- <br /> of <br /> Number of lines---------2-----------------------Length of each line------..Trf- -__ Total filen length nth--�ttb, ---------------- <br /> Type <br /> -----•.----- <br /> Type of filter mafieriaL� oC_ ------Depth of filter material------ g _' <br /> Seepage Pit: Distance to nearest well__-_~—*--------Distanceom foundation__19° <br /> -----------Distance to nearest lot line_ ___f..___.._ <br /> Number of pits---- :�_-_----Lining material__.6C -------Size: Diameter._._.!_3_:�------:Depth-----------��...-••-----••- <br /> Cessp I: Dis#ante from nearest well_________________Distance from.foundation._--___.-_._---.---.Lining material__._-_____._.----------••------•---•- <br /> -------------Li uid Ca aci gals. I <br /> ❑ Size: Diameter r Dep}h q. p ty.. <br /> Privy: Distance from nearest well-__-________________----------------------------Distance from nearest building___-______._____------_---_-••---------- <br /> ❑ ------------------------------------------------- <br /> .to nearest lot line-------------------------------- --------- ---------------•-----•------•------- <br /> ( 4 <br /> Remodeling and/or repairing (describe):-----------------------------------•----------••----------------•----------•--------------------------------•--•-•----....... -••--------•-•-- .. <br /> t <br /> --•------- <br /> -------------- <br /> ---•----------------•----- -- i ..I ! .---- ----•--------------------•-----------------•-----•------------------------------------------------------------------------------------ <br /> ------------ <br /> e <br /> - ---_. - <br /> --- ------------------------- --•------•----------------••--------------•------•--------- <br /> f <br /> hereby certify that I p :pared this application and that the work will be done in accordance with San Joaquin County <br /> have <br /> ordinances, State laws, and rules and regulatio of t e San Joaquin Local Health District. j <br /> Si ned ---•-- - --- -------- <br /> ------------(Owner and/or Contractor) „ <br /> --- -- -- -------------------------------------------------(Title)------------------- ----------- -------------- ................ <br /> of system in relat' n to wells, buildings, etc., can be placed on reverse side). <br /> By: -------- <br /> (Plot plan, showing size of lot, Iota ,! ' <br /> ( FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ----- -- --------------------------------------- DATE--- -- �---------------- <br /> REVIEWED BY --- DATE---•--------------------------------•----------•------------ <br /> . •-----... ... <br /> BUILDING PERMIT ISSUED - ------------- DATE <br /> Alterations and/or recommendations:__------------------------------------- -------------- <br /> ------------------------------------------------- <br /> s <br /> ------•-------•------•-------------•--------••- <br /> ---- ---... <br /> l ---------------------------------------------- <br /> FINAL INSPECTION ------ <br /> t Date--------------- - $- - ,— <br /> - ---------- ------ <br /> r ; <br /> Rx SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> § <br /> 130 Sovth American Street 300 west Oak Street124 Sycamore Street 205 west 9th Street <br /> , <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISE 8-59 2M 5-62 ATLAS <br />