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FOR OFFICE USE: , <br /> --------------------- ----------------------------------- <br /> ---------------------------- -- <br /> ______________________ APPLICATION FOR SANITATION PERMIT Permit No. . <br /> --------- ------ --------- ----------------------------- (Complete in Duplicate) Q <br /> Date issued <br /> _-__---------------------------------------------------- This Permit Expires 1 Year From Date Issued X . <br /> � - <br /> Application <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 /> l/iso N- k FF <br /> J08 ADDRESS AND LOCArTION �'/ C �� -�----- _' -- ---------------------�S j--2�fid----?f---------- <br /> Owner's Name--------- ---- Phone------------------------------------ <br /> Address--------------- -----�. �-9 <br /> °L.2�--------,a,--------- --------�Y --------------------r' �°'{ ------------------------------------------------------•-------•-- ---------- <br /> Contractor's Name--- -v Phone.. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial j�] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table 1-0- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑: Gravel ❑ Sandy Loam M Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-------------.......-) No ] New Construction: Yes Pd 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: „_fDistance from nearest wek---/."--'----Distance from foundation---Jd'_--_-_.Materia l __ ______________y---_-----._--____---. <br /> [ yf , No. of compartments----ly----- -------- - - y;r 9 ---------------Liquid depth---�--------- P Y-'f F---------.... <br /> - Size------�- :,� '� --------Ca out -- -� <br /> Disposal Field: Distance from nearest well_4`4_------.-Distance from foundation--fid--.--------.Distance to nearest lot line--- -----_-- !. <br /> Number of lines---- -- - -- ------ Length of each line----- :._'- ----Width of french.---,r.�_y.--------__-- t <br /> / J F <br /> Type of filter material/1 Ifew---Depth of filter material--/. "--.-_.-.-_Total length- -'---- t -_-�`_---- <br /> Seepage Pit: Distance to nearest well-----___--------------Distance from foundation-----------.-------:Distance to nearest lot line-_--.--__-----.- <br /> [] Number of pits-------;--------------Lining material--------.--------------Size: Diameter-----------------------Depth---.----------------------------. <br /> Cesspool: Distance from nearest well------------------ from foundation--_----------------Lining material________-_--------------------------- <br /> Size: Diameter--------------------------------------De th---.------------------------------------------------Liquid Capacity_ 1 <br /> Privy: Distance from nearest well-------------------------- -.-.--Distance from nearest building-----------------------------------.----.-. <br /> ❑ Distance to nearest lot line----------------------------------------------- ---------------------•------------------------------------------------•--•----- - ------------ <br /> Remodeling and/or repairing (describe= ..�� °� ------------------------`� ?�Lr. ----------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) - ---Owner and/or Contractor .� <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 $Y ----:----------------------------•--- ---------------- DATE--f Q FQ ` <br /> REVIEWEDBY------------------------------------------------------- ---------_:---------------------------------------------------------- DATE-------- -----------------------------------------------.-- <br /> BUILDING PERMIT ISSUED----------------------------------------- --------------------- DAT __ <br /> z <br /> Alterations and/or recommendations:----- ,c___i�� - _-d--__. - v ------ fry -_----�% ��1 !--__ ___-..--__-__ <br /> ------------------------- ----- ----------------------f----------�s-- - -- ------------------------ ------ ------- ``-------z ---- <br /> _ � a- -= - -------- <br /> - - <br /> --------------------------'------------- ------------------------------------------------- ------- ------------------------------------------------- -'.. ,,{W-" ------------ <br /> -------------------------------------------- -------------------------------------------------------- -- ------------------------------------------------------------------------- --- -- ----------------- <br /> FINAL INSPECTION BY:. bate <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Slocktonr California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.P.Ca. N <br /> *i <br />