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FOR OFFICE USE <br /> - -- - ----- --- ----- APPLICATION FOR SANITATION PERMIT Permit No. . ........ <br />-------------- --------------------- ------------------- <br />-----------------*-------------------- --------------------- (Complete in Duplicate} Date Issued <br /> -3 <br /> -------------------------------- • <br /> ------------------ This PeLoctal <br /> Yesa <br /> Dar -i-7w'rk%erein described. <br /> Application is hereby -made to the San JoaquHealth District fopermit to cohitruct and install th; <br /> This in comp iance <br /> _application is made 1' (with County Ordinance No. 549. <br /> dq�. <br /> JOB ADDRESS AW LOCATIONX115P;�__40_&a_ ..t� -----------------.... .............. ---------------- <br /> ----------------- Phone------------------------------------ <br /> Owner's Name----X'(41-cZ <br /> Address-------ItIl-e....Ad-------91 ........ ------ ----------------------------------------*-----------*---------------*------ <br /> --------------- <br /> --------------------- Phone... .............................. <br /> Contractor's Name---------------- ------ <br /> Installation will serve-: Residen"c-s.0—A H_❑-Co-rfffi6FFial"'El'-Trailer.,Cou�t 11 Motel Phone <br /> 0 <br /> partment ouse 11 1 <br /> Number of living units: Number of bedrooms -------- Number f baths I--------- Lot size ------------I------------------­_I--.__:__-_-..--_-____.... <br /> Water Supply: Public systern C1 Community sysr-e <br /> �M­0 Private <br /> Depth Water' e --------Table ft. <br /> .1 F <br /> it <br /> Character of soil to a depth of.3-feet: -Sand.[3- Gravel E].,-Sandy Loam Clay Loam E] Clay E] Adobe E] Hardpan El <br /> Previous Application Made: (if yes,date--------------------) No E] New Construction: Yes Ej No L] FHA/VA. Yes [I No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> A ZZ <br /> Se tic Distance from nearest well___5R------Distance from foundation------�.D---------Material-------&--;------Ao------------------ <br /> .F t Y. ---------- <br /> No. of compartments-------j------------_-Siz 1 01 X4-------Liquid depfh__1.j/--------------------Cap,cl. <br /> t A frr A k <br /> Disty-11 ig "Acundation--------------------Distance to nearest lot line_____.....__..... <br /> Disposal Field- Distance from nearest well-------- 0 om - <br /> 0 Number of lines-----------------------------------Length of each line----------------•------------.Width 0 of trench---- ---.1 <br /> --------------------------- <br /> Type' of filter material-------------------------Depth of filter material-----------------------Total length.......---------------------------------- <br /> OI <br /> Seepage Pit Distance to nearest well-----_---------------Distance from foundation--------------------Distance to nearest lot line---------­----- <br /> F-1 NuAer of pits----------------------Lining material-:--------------------.Size. Diamefev-------------------------De'pth--.---:.......................... <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------I ----------_--_- <br /> Size:�,Diameter--------------------------- -- -------Depth---------------------------------------------------Liquid Capacity-.------ /_--------------gals. <br /> i - . . ............... <br /> Privy: Distzince from nearest well_________________________________._____ __._---Distance from nearest building____'-----------------I.... <br /> Distance to nearest lot line ..........-------------------------------- •----- <br /> Remade'❑ - ----------------------- <br /> -- ---- ------ <br /> Remodrib --------- - ----- --- - - - --------- - ------------­-- -------- <br /> *e and/or repairing (des ribe)- <br /> A.T iw to --------- ­ --------4f-------- <br /> ---- - ------------------ --- <br /> ----------------- <br /> j am <br /> ---------------­-----------------------­------------------------------------------------------------------- -------------------------------------------------- --------------------------- <br /> ---------_-------------- <br /> ------------------------------------------:---------------------------------------------------------------------------------------------------------_--------------------------------_.-__--- <br /> I hereby certify that.I have prepared this application and that he work will be done in accordance with San Joaquin County <br /> ordinances, Sla laws, and rules regulations the San Joa/yfri Local Health District. <br /> ----------- -----------------------------------------towner.and/or C;ntractorl <br /> (Signed ....... -- ---------------------- <br /> 494� -------------------- ------- ------- <br /> By:....... ------ .. .... .. .....1 -1- - 1. ==.7= __(Title)--------------------- <br /> --- - -- ------------ - ------- <br /> (Plot plan, showingsizeof FX, 16-,itiot of system in relation t ells, buildings, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION_ACCEP:TED_BY__,__1422 -------------------I------ --- DATE------------------------------------------------------- <br /> REVIEWEDBY-------------------------------------------------------------------------------------------- ----------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE_----------------------------------------------------------- <br /> Alterations and/or recommenctations:------------------ ------------------------------------------------- ----------_---------------------------------------------------------------------------- <br /> ---------------------------------------------------------- -------------- ------------------------------------------------------------I------------------------------­­11---------------------------------------------- <br /> ---------------------------------------------------------------------------------I---------------------------------------------- ............................. -------------------­I <br /> ---•-----------• -------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------I-------------------------------- <br /> ----­---------------­­--------------- ---------------- -------------------------------------------------------------------------------------------------------------- ----------------------------:----------------------- <br /> FINAL INSPECTION ------------------- Date--- ---------- -------------------------- -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street ,124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />