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FOR OFFICE USE: , <br /> ---------------------------- ------------------- -°----- APPLICATIONt, �— <br /> --------------------- ------------- <br /> FOR -SANITATION PERMIT Permit No. <br /> -- -------------- ----------------- ---- ------------ - <br /> - �'-�-..- (Complete in Duplicate) <br /> Date issued _. _.__���__�.�' <br /> ---------------_------_---______---------------------- This PermiV'Expires 1 Year From Date Issued . <br /> __ _• Application is hereby made to the San Joaquin Local Health Dist i f`for-a:permit to construct and install the work herein described. <br /> This applic`afion radar-in-compliance_ with County Ordinance No. S49. <br /> JOB ADDRESS AND LOCATION---•---••--- '-------�-'3-�•L----------�--- .� T`� •••--• - _ <br /> j ------------ <br /> Owner's Name f/ � ----- Phone.-/ :•� o <br /> ----•---•--------------- J------------- -- 1 <br /> Addressl-C-- -j�-----=------------- :..- .`''``--------------------------------------............................. <br /> Contractor's Name---------------------------------------------- ------------------•----•--•---------------_---.-------------------- Phone.._._---_-----------------_ <br /> Installation will serve: Residence [ff Apartment H Commercial ❑ Trailer Court ❑ Motel ❑ Other [-I <br /> Number of living units: ----1__ Number of bedrooms .-3_. Number of baths ._a'___ Lot size -------e,'-' ��._..�._-... .............. <br /> Water Supply: Public system 0 Community system ❑ Private ❑ Depth To Water Table <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ElSandy Loam [IClay Loam & Clay ❑ Adobe[3 Hardpan <br /> i Previous Application Made: (If yes,11date--------------------) No,® New Construction: Yes ElNo [fit FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> k (No septic fAnk or cesspool permitted if public sewer is available within 200 feet.) <br /> I <br /> Sept Tank: Distance from nearest well-----------------Distance from foundation-------------------Material---------------------------------------- <br /> No. of compartments--------------------------Size-_...---------------------------Liquid depth--------------------------Capacity_-----------__ <br /> Disposal Field: Distance from nearest well.....______--_._Distance from foundation•____�_ _'_.Distance to nearest lot line-___ <br /> Aoyl/'ter, Number of lines............,-./___-_________._Length of each line____I______fi.''�________.Width of trench----------------?- ----------- <br /> --------- <br /> _•____-__ <br /> Type of filter material._ Qs-rte -._-Depth of filter material______ _h_-_.Total length----............r�,�/.._d_________-.___-__r <br /> Seepage Pit: Distance to nearest well------..__--=------Distance from founda4n____,&<.Q....._..Distance to nearest lot line------- <br /> _ ----Size!., Diameter-------- - ............�: Depth------�.__,r�._.`.. <br /> gf Number.,:of Pits______.__!._ _____Lining material__-___ <br /> Cesspool: Distance from'nearest.,well--___- _�------ stance,from foundation_____ _____________Lining material------------------------------------- <br /> ❑El Diamefer----- = '�:P-De th---------- -------------------1--------------------Li Liquid Capacity _gals. <br /> . . . t „ 16. 1 P q P tY <br /> V Privy: Distance from nearest"weil-w-- ----------l °`'"'_,________\____Distance from nearest building <br /> ❑ Distance to nearest lot l�`° e------------------ -- ------------ ---------i-=--�-....-•---- -•-•--------- <br /> ---- ----------------------------------------- <br /> )i4- ------ - <br /> Remodeling and/or repairing )describe):-------$G-- p----------- <br /> --------- L --�'-�----- ��__-r- --------/=------------------------------------------------------------------------•----------- <br /> --­ <br /> ------------------- <br /> - <br /> i <br /> ----•-.---\-:---;-••-----'�------------ ----------- -------------------------- ---------------------------------.----------------------------- <br /> ! hereby certify that I have prepared this appli-ation,a`nd that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the Siii-Joaquin Local Health District. <br /> Z r ------------------ --------------------------- -------------------------------------(Owner and/or Contractor) <br /> (Signed)-------- --- - -�_l <br /> By:------------------------------------------••- ------------------------------------- ------------------------------(rifle)--------------------------•------------ ---------------- <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 /> REVIEWED BY DATE <br /> - -----••----------•---------•----- ------- <br /> BUILDING <br /> PERMIT ISSUED----------- E-_.'------ -------------------------------•-----—----•--------------------------------- DATE--------:--------------------- ---------•--------•-----•---•- <br /> Alterati <br /> I ss a_.G./or romm dations: - <br /> : . <br /> - - - ---------¢z ----------- ------ <br /> --------------------- -------- <br /> --------------------------------------------e <br /> ------------------------------ - --- ...... ------------------ <br /> I � ... <br /> 1 ��FINAL INSPECTION BY:.----- �j- .�`-"=--"---•-.... Date � � � 1���--------------- <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Woof Oak Street 144 Sycamore Strttt 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS - <br />