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12 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...� �j�_ <br /> y {Complete in Duplicate) <br /> This Permit Expires ] Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for f <br /> q permit to construct and install the work herein described. <br /> This a plliicatlon�is made,in-compliance with County Ordinance No. 549. <br /> JOS ADDRESS AND LOCATION__._ <br /> Owner's Name_- <br /> Address ' t+ .Q'�.•� ------------------------------------- Phone------------------------------------ <br /> .--- ---1�� --... <br /> i <br /> - - -------------------------------•------ -------------•-------•------------------------ P <br /> Contractor's Name---e4z%92m ......--••----------------••---•- --------------------• --------------------------------------------------------------- Phone------- •------- <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----1--- Number of bedrooms _- -_ Number of baths A----- Lot size - - -�.�_ _______ <br /> Water Supply: Public system ❑ Community system ❑ Private (E Depth to Water Table 10-- ff. 1 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam PE Clay ❑ Adobe ❑ Hardpan ❑ 1 <br /> Previous Application Made: Yes [: No ® New Construction: Yes ® 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: Distance from nearestwell_sP__.__---_Distance from foundation----I-Q'----- _MateriaL�s,=------------_----------•• I <br /> xNo. of compartments------�.--- --- -----Size- ?�A_.�5__4�---_-------Liquid depth------4-----------------Capacity-_'%DQ------------ <br /> Disposal Field: Distance from nearest well. SP._____Distance from foundation----11 _-----Distance to nearest lot line--r I--------- <br /> Number rof <br /> --------Number.of lines------:X ----------------- Length of each-line----------$_0--------__----Width of trench_-,.'j-_--- ------ ----.--- q� <br /> Type of filter materiaiK ------Depth of filter material-----1-111---------Total length----1_b-D'--a________________________ <br /> Seepage.P;it.: Distance to nearest well---------------------- from foundation-------------------- to nearest lot line__------_--_---- <br /> ❑ at. Number of pits----------------------Lining material---------- ---------- -Size: Diameter----•------------------Depth----- -------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-----__-_.-------_-.----___---------. ,r's. <br /> ❑ Size: Diameter-------------------------- -----------Depth---------------------------- ----------------------Liquid Capacity-----------------------•---gals. <br /> Privy: Distance from nearest well---------------------------------------_--------Distance from nearest building------------------------______-__--____ <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------- <br /> S , <br /> 5. <br /> Remodeling and/or repairing (describe)----------------------- --------------------------------------------------•------•-•---------•------ -- --------•----•------•-------•--------------- <br /> ---•----------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- <br /> 1 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 /> (Signe - <t---------------------- -----------------------------------------------------------------------------------------------------------(Owner and/or Contraciorl <br /> Sy:----------------- ---------------------------------------------------------------------------------------------------------------(Ti+le)--------------------------------- <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 I3Y---- 1' <br /> ---- -------------------------- <br /> REVIEWEDBY------------------------------------ ----------------------------------------------------------------------------------------- DATE-------- -- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE <br /> Alterations and/or recommendations:----------------•-------- ------------------------------------------------------------ <br /> ---------------------------------------_--------- --•--------------------------------- ------------- --------------------------- -------•--------------•--•------------------------------------------------------------ --- <br /> ----------------- --------- -----------I------------------•---- ------- ---------------------------------------------------------­­--------------- ---•----------------------------------------------------------------- <br /> ----------- ---------------------------------------------------------------------------------------------- --- -----------------------------------•------------------- ----------------------------------------- ------------- <br /> w / <br /> FINAL INSPECTION BY:. Date ( Ca Ca <br /> _A094t -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North."C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 8-'59 F .Co. <br />