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'FOR OFFICE USE; <br /> -------------------- <br /> ------------------- ---- ---- ------- APPLICATION FOP, SANITATION PERMIT Permit No. <br />--------------------------------------------------------- (Complete in Duplicate) <br /> --------- ------- --­----------------- -------- This Permit Expires I Year From Date issued Date Issued <br /> ------------- <br /> ------------------------ ------------------- ;2-3-6 L(2,0 <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 incompliance with County Ordinance Nom-549._t <br /> N- ----------- --- <br /> DRESS AND LO ATION_ <br /> JOB AD - ------- r- - ----------- - Phone---- -------------------------- <br /> ............. <br /> Owner's Nam _�5 - ----- --- --------- - ------------ --------------------------------- <br /> m ---. .......... <br /> Address-- -----AIF ------------------------- ------------------------------------------ Phone-------------------- -------------- <br /> Contractor's Name---- --------------------------------------------------------------------------------- ------------------------------ <br /> Installation will serve: ResidVnce E] Apartment House El Commercial E] Trailer Court 0 Motel I--] Other <br /> a A. <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------------------------------ --------------------------- <br /> Water Supply: Public system El Community system El Private K Depth to Water Table <br /> Character of soil to a depth of 3 feet- Sand Gravel K Sandy Loam Ll Clay Loam El Clay ❑ Adobe E] Hardpan C3 <br /> /VA: es N <br /> I I <br /> Previous Application Made: ;If yes,date-------------------- N OIX Now Construction: Yes Ej No FHA <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ?wifhWlnq� 00�feet.) iZd <br /> 2 <br /> 4" <br /> (No septic tank or cesspool permitted if public ewer is available 46.�l <br /> -on M fegial----- -------- -------------------------- <br /> Septic Tank: Distance from nearest wel&W--------Distance from foundation___ jP_----- <br /> 41' ap ?_Cq5��Z------- <br /> No. of compartments----_---= ------Size--,,--Y---j'Y__,z57�Liq,id depth_ C acity-A <br /> Distance from near t Distance from foundat1ori_.__,;a-_-%?� -Distance to nearest to IP* --';>---------- PI) <br /> Dispel Field: _-Z <br /> *7 4� / Width of trench.- ---------------- -------- <br /> --------- ---Len ---------------------j------ <br /> Number of lines --------1.5 gth of each line 17-1517 <br /> Type of filter material5l)el�elk_Depth of filter material-----g__45/'_+_TofaI length___.__ <br /> --------Distance to nearest lot line_"-._.____"____-. <br /> Seep . Pit: Distance to nearest well------- --------------Distanite from foundation <br /> jae Number of pits----------------------Lining material---------- <br /> Size: Diameter-----------------_---Depth--------------------------------- <br /> Distance from nearest well-----------------Distance from foundation--------------------Lining material__..-__.._--------- -------------- <br /> Cesspool: Capacity----------- gals. <br /> ElSize: Diameter--------------------------- ----------Depth---------------------------------- -----------------Liquid ------ <br /> ----------------------Distance from nearest building----------------------------------------- <br /> -Privy, D istanc�.-,f�dm'n(�a rest well-------------------------- <br /> �G <br /> Distanceto nearest lot line-------------------------- --------------- ------------------------------------------------ ----------------------------------------- <br /> Remodeling and/or repairing (describe):_------ --------------------------------------------•----------------------------------------------------------------------------- <br /> -------------I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> _ <br /> ----------------------------------------------------------------------------------------I-----------I-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - - -- --- - -- - - ------- ---- ------ ------ ---- ---- -- <br /> -------- - ------------- <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, Stale�,W;Rl, and rules and/relations of the San Joaquin Local Health District. C <br /> ------------------------(Owner and/or Contractor) <br /> --------g-e�__ - ------------------I---------------------------------------- <br /> (Sign ecl)--.--\.-___�__�A_ - <br /> Sy:----------------------------------------------------------------------------------------- ----------------------- (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-------------- ------ ----------- -----------__-------------------- DATE--- --------------------- <br /> ----------------------------- <br /> DATE. .------------------- ----------------------------------------------- ------ E <br /> REVIEWED BY------------------------------ 0 ) <br /> ------ DATE---------------------------------------- --------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------ ---------------------------/ <br /> Alterations and/or recommendations_____________._..----_ ._ ---------- -------------------------------------------------------------------------------------- <br /> -------------- _---------------- ------ --------------------------------I......­_­--- ---------------------------------------------------­----------- -------------­-----------I------------- ------------------------- <br /> - <br /> --------------------------- ------------------------------------------------ ------- ------------------------------------------------------- ------------ ----------L------------------------ -------------------- <br /> ---------------- <br /> ----- ------------------------------- --- ----------- ----------------- <br /> -------------------------------------- - ------------------------- ----------- --------------------- ------ <br /> 6 <br /> Date.----- --------------- ­­---------I---------------- ------ <br /> FINAL INSPECTION BY:--------- - -- ----------- --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 SYCOMOTS Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 9:5 9 REVISED 6-59 31A 3-'63 F.P.1213, <br />