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FOR OFFICE USE: <br /> ---------------------------------------------- ----- No. <br /> __)w APPLICATION FOR SANITATION PERMIT Permit <br /> --------------- ---­------------------------- (Complete in Duplicate) ssued ... A <br /> This Permit Expires 1 Year From Date Issued Date I <br /> ------ ---- --- --- -------- --- <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 649. <br /> "ce o.,54Y <br /> JOB ADD -----------------------------------...................................... <br /> RESS AND LOCATIONJZ ---/----- - <br /> . ----------- -----­----------- <br /> Owner's Name, Phone.... <br /> ------ ----------------------------------------------------------------------------------------- <br /> ........................... <br /> Address--------- ------------------------- --------- <br /> ------------------------------------------------------------------------------ <br /> Contractor's Name--------------_-• ---- -- ------- I --------------------------------------------------- Phone----------------------------------- <br /> LA�� - - ------------ -------- <br /> Installation will serve: Residence Z"Apartment Hoise E] - Commercial [-] Trailer Court El Motel [3 Other El <br /> Number of living units: ---/-- Number of bedrooms Number of baths J.... Lot size ...... <br /> -------------------------------- <br /> Water Supply: Public system W�Community system [:1 Priv6te�4]1�- Depth TO Water TabletAV,t. <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel El Sa.nd'y'idarri E) Clay Loam E] Clay [] Adobe[Hardpan ❑ <br /> 1-1 <br /> Previous Application Made: (If yes,date-------- -----------) No New Construction: Yes F] No ES FHA/VA: Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> q. I <br /> Se ,tic Tank- <br /> Distance from nearest well_________________Distance from foundation------- <br /> __.Material-----------------------------------_---------- <br /> No. of compartments--------------------------Size_-_---------------_--- --Liquid depth----- ------Capacity------------------_ <br /> lot line---/0�_'OL <br /> foundation.___----------Distance to nearest <br /> Disposal Field: Distance from nearest well--- Distance from h <br /> of each line - --- ---11---j__ <br /> Number of lines_ '....Width of trenc <br /> P --Total length__,10----------------------------- <br /> /�Z WfZ material..-"/ <br /> Va <br /> At - --------- <br /> Type of filter r�a�erial./. ppth off m <br /> Seepacie-PY Distance to nearest is ancel f d tion �4jP?._�.b­s'"nnce to nearest lot lize--- ---------- <br /> .......D' t r-qrn ovp a 1 ...: W 0 / <br /> ---Size: Di-...-. - - --------------- <br /> _W_*_V V Depth-A------------_------------- <br /> OMM 9 � �w 41 <br /> 4, Number of pits------/-------------Unin ,material.. <br /> 47 Ar <br /> from foundation------------------tining material_____-_"-_-___..-___"_"--______..._-_ <br /> Ceos:�OoAk Distance from nearest Dista4c@ <br /> V <br /> El Size: Diameter--------------------------------------Depth_'.-----------------------------------------------_Liquid Capacity---------------------------9015. <br /> Privy- Distance from nearest well--------------------------------------------.-----Distance from nearest building------------------------------------------ <br /> ClDistance to nearest lot line------ ------------------- ----"-------•---------•----- --------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------------------ ---•-----------------•------ <br /> ------ - ----------- ------ .............*---------------- <br /> ­--------- --- ---- ----- ----_-------------------------I-------------------------------------------------------------- <br /> - ------------- ----- ------ -W----- --- --------- ----------------- <br /> --------------iiu& /444e -------------- I -------------- <br /> ------------------------------------ -------------------------- ----------------------------------------------------------- ------------------ <br /> ------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances, State laws, a rules and regulations of fhe,Sap Joaquin Local Health District. <br /> ii L-oo GkvmstmjMd;�or Contract <br /> (Signed)-------------- -----------J04- -v- - -- ------ -------------- <br /> P7 <br /> ---------------- <br /> ar <br /> By:--------------------------------------------------------- ------------------------ . ........ <br /> (Plot plan, showing size Of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> F, <br /> --------------------_- DATE <br /> ........... ----------------- D <br /> APPLICATION ACCEPTED BY---- ---------------- ------------------- ------------------------ DATE ... ... ------ —-------------------- <br /> ---------------------------------------------- <br /> REVIEWEDBY-----------------------------------------------------------------------*-------------- -----------------*-------------------- DATE------------- <br /> BUILDINGPERMIT ISSUED---------------------------------- -------I-­---------------­---------- DATE---------------------------------------------------------- <br /> Alterationsand/or recommendations:------- ------ _ ---------------------------------------------------------------------------------------------------------------------------_----------- <br /> ......I------------------- -------------------------------------------------- -------­---------------------------------------------------­-------------------------------------------------------­­---------------------- <br /> -------------­-----------------_---------- -----------I-----------------------------------------­---------------------------------------------------------------------------------------------------------------------- <br /> --------------- -------------------1---------------------------------------------­--------------------------------­----------------------------------------------------------------------------------- ----------------- <br /> ......I-------- L------------------­­---­------------------------ -------------------------- ---------------- ---------I------------------------------------------------ ------------- --------------------- -------- <br /> FINAL INSPECTION BY-------- - ----- ---------Z&7 Date-----------;7,� - -- -, -I- ----- ---------------------- --------------- <br /> 711-_63/a <br /> --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISF13 B-59 2M 5-62 ATLAS----- <br />