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� FOR OFFICE USE: - <br /> r <br /> APPLICATION FOR SANITATION PERMIT Permit No. ................... <br /> --------- --------------------------"---------- (Complete in Duplicate) Date Issued <br /> --- --,. --` -- T <br /> -'This Permit`Ez ices l Year From Datta issued ' " <br /> ' s. 1 <br /> Applicatiori'-is'hereby made4.to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. <br /> This`appllication.is made'in.compliance..with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION --------- --•----------------------------------- <br /> Owner's Name-"------ --------=-- meg !_� �4_I�,-----= ----------------------------------• Phone....------------------------------ <br /> Address------------ t --------------------------�' <br /> ----- <br /> r Contractor's Name----------------------------------- <br /> -------------- ".- _' -Ar c-71i�c -- ---_--.:--------- Phone------------------------------- <br /> r ., i <br /> Installation will serve: Residence 4 Apartment House '❑_ Commercial ❑--7Trailer Court ❑ Motel ❑ Other ❑ <br /> Number ofliving units-.-_---- Number of bedrooms Number of`baths .a Lot size _----_ _------------------------------------------ <br /> Water Supply: Public system Community system ❑ Private ❑ \Depth to Water Table -------- ft. ' <br /> Character of soil to a depth of 3 feet: "Sand 0 Gravel ❑ Sandy Loam'❑ jClay Loam ❑ Clay ❑ Adobe' " Hardpan ❑ <br /> Previous Application Made:'(If yes,date:!.-.-.- ---) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t <br /> .� (No septic tank rar cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---- __"__-_Distance from foundation-----La---------.Material�'� ------------- <br /> �J No. of compartments------ �"-------------Size---- -X__3__x'- - --Liquid depth--------f-_------------Capacity-tea-.p---------- <br /> Disposal Field: Distance from nearest well...:_S:b_'`.Distance from foundation__--_-_2A ---.Distance to nearest lot line----. -------- <br /> Number of <br /> -------Numberof lines_____________ <br /> + Length of each line W,dth'of trench. ------•--------- <br /> Type of filtermaterial- - :- c-&epth of filter material---- "��-_-"_Total length i__--1 -_--- ------------------------------5 <br /> Seepage Pit: Distance to nearest well- ---" 6"0-.-----Distan from n ation....... <br /> �..-..Distance to nearest lot line-------- <br /> Number of pits_-------.,2__•------Lining mat <br /> -_-- o ---- --_-- ize: Diameter-_. _"-----------Depth-----af..--••-----"-...- <br /> Cesspool: Distance from nearest well-----------------Distance ndation___.____------.---.Lining material------------------------------.____--_-. l <br /> ❑ Size: Diameter------ --------------------------------Depth--------------------------------------------------Liquid Ca ace =----------- gals. \ <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--- <br /> Distance to nearest lot line------------- ------ --------- <br /> Re l F ( ----- i <br /> amodeling and/or repairing (describe)-------------------------------------------------------------------•---------------------...........-•--------•-----`------•--••---------._._...----•-- <br /> i � . <br /> -------------------------- --•-------------------------------------------------------------------------•----....-------- --------------- <br /> -----•------ ------- ----------------------------------- ------­----------------------------------"---•--------------- ---------------•--------- =----- <br /> I 3 i------------------------ = <br /> ---•----------------••--•---- --•----------------------------------•---------------•----------------------------------••------•-------•-------------••-----•--""-- ----•-------------- <br /> I 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 an� regul�latiio, o s of the;San Joaquin Local Health District. ! <br /> {Si ned � T-7--eulA� ----- <br /> 5 )----- -- - -•------- - - - ----------------------- - - -- ---------------- --�------ ------------------------------------ • •------- --{Owner and/or Contractorl <br /> Plot Ian, showing size of lot, location of system"!in relation to wells, build'-"" s c., {Title}__"_---"--_"""""""_--"""�".-"--.-""_.-..__'....-.----"--_"--" <br /> Y:---------- ----------------- "------------------------------------ --------------------------------------- <br /> { p g y Ings, etc., can be placed on reverse side}. <br /> _ — M <br /> t FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------794 --------------=---------- _----------- DATE-------- r ' l <br /> REVIl;WED BY = -----------------------" ------ DATE----------------------- <br /> BUILDING PERMIT ISSUED- —--------•------ ---------------------- DATE------------------------- <br /> Alterations and/or recommendations:--------------------------=.....------ - -----------'----------•`----------=----- <br /> ------------------ ------ <br /> /fit!, O <br /> � //�.,� � -:----- -• -- __ <br /> ------------------- T� ----•--- = ------- <br /> --- ---?--,-a -�_ _ <br /> -----------•----------------- ---- 1 <br /> FINAL INSPECTION BY:: --- -------- Date----- ll it <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore street 205 West 9Th Streat <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EH-9 PEVIBEO B-59 P.P.00 2M 6-60 <br />++A <br /> A • <br />