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F=ORD OF----IF`S : <br /> - ------ ---- <br /> ✓L <br />__. ..:........._ ;l____--__-_--_--._.------------- APPLICATION FOR SANITATION PERMIT Permit No. ....1.....1!0. �. <br />---------------------------- ------------- -------------- (Complete in Duplicate) S <br /> ___________________________________________________--- This Permit Expires 1 Year From Date Issued <br /> Date Issued ....�.... ...... <br /> 7-- <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 rdinance No. 549. <br /> JOBADDRESS A QC ION r�- ------------------------------------------------------------------------------- ---- --------------------------- <br /> Owner's Name. --- 4 .. Pho e. •--_----- . -•------------- <br /> -------- <br /> Address..... Q � -----�-----�'------� ....*.."_...... ,.�.......... <br /> Contractor's Name... ` ------•---•---------------------------------------------.......................... <br /> Phone.............---...---.......... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of baths _ Lot size ... SS�t _ —--------------------------- <br /> Number of living units: __�._._ Number of bedrooms 2.. �_. . <br /> -- - ---------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table _ 0 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date-OA.2142) No [ New Construction: Yes eNo ❑ 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 nk: Distance from nearest will_'_— _-_.-_Distanc from foundation__�d------------ <br /> Material..�..................... ......,_,....... <br /> No. of compartments----- <br /> ._____---___.__Size___ ____._..Liquid depth_._. . __ <br /> _._... _._Capacity----- ......" -'tel <br /> -----'� <br /> Disposal Field: Distance from nearest well------ .___._Distance from foundation.1p.•_-__-.--_-Distance to nearest lot line...U'r........... <br /> Number of lines-_--__--_-_.� Length of each line_______c7O..............Width of trench........Zk.............. <br /> 11 <br /> Type of filter material�dC_ti.--_-_.-Depth of filter material__/ '_____________Total length.........._2fl........................ <br /> Seepage Pit: Distance to nearest _ <br /> well---'"'------------Distance foyndation_-�---------.,Qi�r�e to nearest lot line....../. <br /> [� Number of pits----/----------------Lining material_____y_ _ _...Size: Diameter___•__3_..._.._ --____-Depth_- ._� <br /> _- 4!......_.... <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..................................... <br /> ❑ Size: Diameter-------------------------------------Depth-----------------•----------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------_--------------------------_-------Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line------------------ -------------------------------------------------•-------------------------------•-------................................. <br /> Remodeling and/or repairing (describe):-------- -----------------------•..--------•--------------•-•---------------•---------------------------•-•-----•-----•------•-------•--------------•---- <br /> --------•-------------------------------•--------.---•------•-•-----------•---•-----•----------------------- -•----------•---------------------------------------•----.---•-----------••---•--•--•---•------------------•---- <br /> ----•-•-------------•------•-•-----------------•---•--------------•-•-----•---------------------------------------•------•---•-----------------•------------------------•-----•---------_-••-------_._......._......._...... <br /> •-----•--------------------------------•---------------------•------•--------•--------•-------------------------------------------.-----------------------------------------•---•-------_..--_----••--------------------.._.. <br /> I hereby certify that I have prepared this appli Ion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations o h an Joaquin Local Health District. <br /> (Signed)-------------------------------••--------......--------•-- ---------------------------------------------------------------------(Owner and/or Contractor) <br /> By:-------------------•--------•----------•--------------------------------------- -----------------------------------•.(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 EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- _2....... -- ------- ------ --------------- -------------------------------------- DATE........ <br /> 1 . <br /> REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------- DATE............................................................ <br /> BUILDING PERMIT ISSUED--- --------------------------------...................................... DATE-----------------------------------------------............. <br /> Alterations and/or recommen tions- -- <br /> ,J ..__. <br /> ...... sy <br /> ....-----•-•-----------------------------------------------•--.--_.--_----------------_-------------..-------_------------------- ------------ - ..........................................................................____....... <br /> ..............................................._.................__._.....--.----._.'_-------._._....--'------------------------------------------•-------•------•-•-----------------•-----•--------------.----•----•----•-- <br /> ................. ..................._...'------'----'_.---------- ------- _ <br /> _... ------------...---- -----.------•-------•-----_____----------•---•------------•----------•---•---------.._-.-.------•-------•---•----•--- <br /> FINAL INSPECTION BY:.-_- �-- L� D - --•-� -- -- --------- <br /> f `--- - ------ ate --•- ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wort Oak Street 124 Sycamore Street 205 West 9th Strout <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br /> - 7 <br />