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f FOR OFFI E USE: '30 - - _ Permit No. _10� 7 <br /> 9 rL b3�^r ~' <br /> I _ APPLICATION FOR SANITATION PERMIT <br /> rl��C--- ---�' - <br /> . .... <br /> ------ (Complete in Duplicate).. Datb issued <br /> "--------------- # <br /> ----------- <br /> _ _._".--- Thts Permit Ex ices 1 Year From Date Issued <br /> App <br /> lication is hereby made to the San Joaquin Local Health DiNoc 54or <br /> 9 a permit to construct and install the work herein described. <br /> This application is made in compliance with County <br /> �yy� / '�-- <br /> ----------------•--------------------- = <br /> JOB ADDRESS AND LOCATION_..--� a-'�___ r��� Phone-------- --------------- ---------- <br /> I LLII -- <br /> ---------------- --------------- <br /> ------ <br /> Owner's Name--•---�1'�- -- ��----•--- ----•-------•----------------------•--•----------•------------------•----•-•-- <br /> �1 ----------•------ <br /> Address. l. - Phone---------------------------•------ <br /> ------------- ----------------•----•------ <br /> -�------------------------- •-- Other ❑ <br /> Contractor's Name------------- - <br /> Motel ❑ <br /> I Installation will serve: Residence (r Apartment House ❑ Commercial ❑ Trailer Court ❑ y <br /> F Number of living units: __"-t-- Number of bedrooms .- •. Number of baths _-_---- Lot size -- p--� Q •---------------- <br /> e th to Water Table lep ft. <br /> Water Supply: Public system ❑ Community system ❑ Private P <br /> PP Y� Clay Loam ❑ Clay ❑. Adobe[Hardpan ❑ <br /> Character of soil to a depth of 3 feet. Sand ❑ Gravel.❑ Sandy Loam ❑ Y <br /> Application Made: (if yes,date---------------- -1 No <br /> New Construction: Yes-E] No 0� FHA/VA: Yes ❑ No.� <br /> Previous App <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool.permitted if public sewer is available within 200 feet.` <br /> �/�-_Distance from foundation---[D----------Material__ --- j <br /> Septic nk: Distance from:`�nearest well_-------- <br /> 3�C-5_�x_g_- _Li uid depth----'-4-- Capacity <br /> No. of compartments..._A-.- ------"- <br /> = -Size----------=- Is q / <br /> I f r <br /> I f 4--------------Distance to nearest lot line._ <br /> Disposal Field: Distance from nearest well__'4 ------- Distance from foi n anon_ <br /> I Number of lines-------�------- ------------'----Length of each line_--7Q--------------------- <br /> ----;�----:---Width of trench_- 2f------------------------ <br /> Number <br /> ----- ------ -------- <br /> Type of filter material-e— eA--------- of filter material-__I-Ir-------- <br /> ------ -- <br /> Total length. �d ------------------- <br /> Type <br /> ---------------- O <br /> Distance from foundation_ d----•------Distance to nearest lot line_ .------- y+ <br /> E. <br /> ` Seepage Pit: Distance to nearest well- Iain rriateria4 clt------Size: Diameter"--- - ----- - ---Depth-.- `5----" <br /> I <br /> Number of pits------I-------------- g <br /> Cesspool: <br /> Distance from nearest well----------------- <br /> Depth Ce from foundation. ._--------------- <br /> _ Liquid Capacity---------------------------- <br /> -- <br /> gals. <br /> ❑ Size: Diameter_-"__.. <br /> Distance from nearest.well-------------"----- ------------ ----=-----------Distance from nearest building--------------------------------------- <br /> Privy'. <br /> --•------ ----- <br /> Priv -----------------------------------------------•----- <br /> -- 0 <br /> ------------------------ ---------- <br /> � ❑ Distance to nearest lot ine_____"------------- <br /> l 00 <br /> Remodeling and/or repairing (describe :---"---- --------------------------------: - <br /> --------------------------------------------- <br /> -----•--'_- -----•-----------"-•"-- "-- ------------„ - ------------------•--------"--------------••----------------'--"--------------------- <br /> ---------•--•-------------------------------------------- <br /> --------------"'-'--- ---------"_--- -"-"-- ------------b*=---_-- <br /> i <br /> ---------------•--------- <br /> --------------------------- <br /> 1 hereby certify that I have�prepared <br /> ula s applicns ati n and that an Joaquin wo Heall he District. <br /> n accordance with San Joaqu9n oun y <br /> ordinances. State laws, and rule and reg <br /> _---.--_.(Owner and/or Contractor) <br /> (Signed)_ ------------ <br /> --------------------------(Title)------------------- ---------------------- ------ <br /> By:-----"-------------••------•---------------------. - <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 /> r � <br /> -- DATE-- `{ r ------------------------------ <br /> ---------------------- <br /> APPLICATION ACCEPTED BY °- - - <br /> -------------------------- DATE------------•---------------------------------------------- <br /> REVIEWED <br /> ----------------- -------- --------- <br /> REVIEWED BY------------------------•-------------------------------------------------------------------------- <br /> ------'---------- <br /> DATE <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------ .: ------ <br /> Alterations and/or recom endations:__-3_'�� � �-- + <br /> -W--------- — -- -•--- <br /> f �+ --o -v -------------------- <br /> -- ------------------------- <br /> -------- -------------- <br /> ------------------------------- <br /> �. <br /> --------------------------------------------------- <br /> ------- ---------- <br /> ---------------- <br /> - -------------- <br /> Date <br /> FINAL INSPECTION BY:-------- -�---- <br /> ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 124 Sycamore Sfireet 245 West 9th Street <br /> 1601 E.Hazelton Ave. 300 West Oak Street Tracy,California <br /> Lodi,California Manteca,California <br /> Stockton,California <br /> ES 9 REVISED B-59 3M 3-'63 F.P.i^O- t <br />