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FOR OFFICE USE: <br /> -- ----------- ----------------- Z,7 <br /> --------- --------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------- ----I-------- (Complete in Duplicate) .. . Z Date Issued <br /> ------------------- This Permit Expires 1 Year From .Date Issued <br /> Al <br /> work herein described. <br /> Application made to the San Joaquin Local Health District for a permit to construct and install the w <br /> No. 549. <br /> application Cie in compliances with County Ordinance N <br /> -------------------- <br /> 3 <br /> JOB ADD.ADDRESS AND LOCATIONIX-11144 ­e <br /> Owner's Name---._�Vll­,­_�Z- <br /> -- <br /> JOB <br /> - ------------- ------ <br /> ----------------------------------------------------------------- <br /> Address-------------d-9--,e..----)—.-,c ------­------------- <br /> ----- Phone-- ----•------------------ <br /> Contractor's Name---------4 , <br /> Installation will serve: Residence [Apartment House [I Commercial E] Trailer Court ❑ Motel 0 Other [I <br /> L . Number of living.units:.__,..__- Number of bedrooms :.C_._ Number of-baths Lot,size --------------------------------------------------- ---------- <br /> Water Supply: Publicisystem El Community system E] Private Ur5Depth to Water Table -------- ft. <br /> S�— Loam. 'am Q/..Clay.0 Hardpan. <br /> Character-of soil to.a depth of 3 feef:.� Sand E] njy _,play Va -Adobe <br /> Previous Application Made: (If yes,date-_---___--- --...-I No-E] New Construction Yes No El FHA/VA: Yes El No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> nearest well__ _______Distap ro m f dat,on Mp f e ri a I <br /> Septi ank: Distance from nean fun i ----- -- -------­ " / <br /> -----------------Capacity---14--P <br /> Sil V-'�r <br /> Nc;. of compartments e__ -!VLiq,id dep.fh--$111--- <br /> DispVosFielcl: Distance from nearest well­.,�--- Distance from-foundation__ ............Distance to nearest lot line. ----- <br /> Number of lines ----------Length of each line__: Q- --_-----Z---------------Width of trench--- -------------------- <br /> ----------- Z <br /> - "R 1 al length-----/--0--A------------------------- <br /> Type of filter material-'---<--- --;-------Depth of filter material--'- -'f ­------f6t "I <br /> /10 1 -Distance to nearest lot line.--__________ <br /> Seep/ae Pit: Distance to nearest well____: d________Distance from_foundation----- ----------- or" -11 <br /> material......*; -&-; ---.Depth----­'�> -`---------------- <br /> Number of pits--------2 .... ..Lining Diameter._. . .... <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--L---------------Lining material___------ ---------------- ---------- <br /> Depth I I -------.Liquid Capacity­-------------------------9all. <br /> E] Size: Diameter------------------------------------ ----r- ---------------------------:------ <br /> Pricey: Distance from near I est well----------------------------------------------- --Di St6 nce'4-FOITT-nea rest bui�cling­I---------------------------------------- <br /> Distance to nearest'lof line------------------------------------------------------ - --------------—-----------------------------•--------------------------------- <br /> ❑ <br /> ----------------------------------------------—-- --------------------------------l�--------- -------------------------------------------------------- <br /> Remodeling and/or repairing (describe ------ <br /> --------------------------:----------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------­­------------------- <br /> --I--I r-----------­---------------------------------------------------------------------------------------------------------------------------i I-------------------------------------------------- ------------------------ <br /> -- -------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- <br /> ti I hereby certify that I have prepared this application and that the work will 67e'done in accordance with San Joaquin County <br /> Joaquin Local Health District. <br /> ordinances, State law nd rules and regulations of the San <br /> C3 1 <br /> Z! —'andlor Contractor) <br /> (Signed)------------------- ---- ------------------ -------- ---- ----- -- -------------------------------------I ----------------------------------- <br /> -------------iTitle <br /> c., can be <br /> i et <br /> ----------- ----------- <br /> By:--------------- --- -------- ------------- 0 w wells, <br /> (Tifle)­------------------------- --------- ----- <br /> - $� 4 ' 5� s <br /> (Plotla <br /> plan, showing size of lot, location- of syste in rela on to wells, buildings.,etc...can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- - - ------ ---------- -- ---------------------------------------- DATE------f ------------------------------- <br /> BY ------------LAI-Af)-------­ ----------------- ----------------- --------------------- DATE----- ---------------------------------- <br /> REVIEWED DATE------------------------------------------- ----------------- <br /> BUILDINGPERMIT ISSUED---------------------------I- ------ ---------------------------­­--------------I---- <br /> Alterations and/or recommendations----=------------------ -- --------------- -------------------------------------------------------------------------------- --------------------------- <br /> -- --------------------------------- --------- ------------------------- - -------------------I -------------------------------------------------------------------------------------------------------- ----------------- <br /> - I -------- ---------------- -- ------------------------ <br /> ------------- -------------------------------------------- --------------------------- --------------------I------------------------------------------------- -- ------ <br /> ----------------- ----------------------------------- --------4-------I-------------------------------------------------------7--------------------------------------------------- ---------------------------------- <br /> ----------------------------------------------- <br /> ------------------- ---------------- - ---------------------- <br /> ----------------------------- --------------------------------------------- --------------------- <br /> --------------- -I------------------- ---------- <br /> -------------- <br /> FINAL INSPECTION BY:------- Date--// <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> CS 9 REVISED 9-59 3M 3-'63 F.F.rD. <br />