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FOR OFFICE USE: <br /> r <br /> -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> -- <br /> --- <br /> --- <br /> ----- ------------------- ----- ................ <br /> ­­----------------- ---------------------- - (Complete in Duplicate) 3 <br /> . Date issued _. ......... <br /> - - <br /> ---------------------- ----------- This Permit Expires 1 Year From Date Issued (0f-7 _ (0 Lf 0,0 <br /> Application is hereby made to the S in 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. 50. <br /> �Z JOB ADDRESS ANDLOCATION-A------� ... -. ------- 'Ca -_X--• --- ----------------- ::-•-- ---_------------ <br /> ` -- <br /> Owner's Name-------- - Phone <br /> ----- .. ----------_•---------------- --- <br /> Address (.J y� ' �`� ��'-----�--'�--- {�l <br /> Contractor's Name---------�f 1��Ir���_..--- = ------- ---- •.------ Phone <br /> installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [I Motel ❑ 2121W { ] <br /> Number of living units: J---- Number of bedrooms ___7 _. <br /> Number of baths .... Lot size .-_'.�_____._-_�-_1'''�'�!'�-------------------- � <br /> Water Supply: Public system ❑ Community system ❑ Private k] Depth To Water Table /,-47 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam P Clay Loam ❑ Clay❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date-------------------1 No New Construction: Yes-M 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 /> R .........Material---41df°?'/ ^'_._----------------------- <br /> Septic Tank: Distance from nearest well__.��______..Distanc from foundation___ <br /> ----Size__ .. '� ------Ca aci --- <br /> No. of compar#menfis-- ��--------- �-�---�----*�-------Liquid depth__...-�----- --- P tY-�-�"G—P---•-•- <br /> e <br /> Disposal Field: Distance from nearest well__X�O------Distance from foundation....J_0........Distance to nearest lot line-1_._........ <br /> 90 Number of lines`_____: ---------------- <br /> �g-q- -_- Length of each line------->r�-_. Width of trench.___Ae_�-_�----------------- <br /> Type of filter material. -hf. DePth of filter material______ ____.-----Total length___ '_________________________ <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-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> El <br /> _____- _________•-__-__•_❑ Size: Diameter-1-----------------------------------Depth-------•--------------------------------------------Liquid Capacity_--------------------------gals. <br /> ! Distance from nearest building Privy: Distance from nearest well----------------------------- ---- g-------•--------------------------------- <br /> ❑ Distance to nearest loft line------------------•--------- -----------------------------------••••--------------------------•--------•------------------------------- <br /> r <br /> Remodeling and/or repairing (describe):--------------------------------------------------------•-•----•--•--------------- -----------------•--------------••----------•- <br /> I1 <br /> ----•--------- -•----------•------- --•-------------- <br /> ----------------------- <br /> --------------------•--.-- ••--------- e -------- <br /> ---------------------------------------------------•--------- <br /> i <br /> County <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> ordinances, �Iaw _a and regulations of the S� Joquin Lacal Health District.S' ned -------- - ------•------------------------------------------------------(Owner and/or Contractor <br /> ( t9 )------ -- _ _ <br /> By -----------------------------------------=-------------------------------(Tittle)------------------- ------------------------ ................ <br /> (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY _ <br /> APPLICATIONACCEPTED BY- p = ----------- DATE--Y'��-`---�--------- <br /> REVIEWEDBY---- -------------------------------- ---- •------------. DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-----__-------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations-------------------------------------- -----.-_.---------------- •----•---------_-_.---.-----•---------------------------------------- <br /> -------- --------•-----------•----------------------•-------•----------------.--•----------•-------- <br /> ------------------••---------•---------•------------------------- ------------- <br /> ...................__-__.._._____________...---_-___-. <br /> ----------------------------------._.----------------------- <br /> I <br /> FINAL INSPECTION BY:. ------------------ Date--- '.a ...`. .. -----•-•-----------------•--------•----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 114 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS 2, <br />