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/OR OFFICE USE: <br /> --- ------------------- --- <br /> APPLICATION FOP, SANITATION PERMIT ermit No. <br /> ------------------------- ------------- ------- (Complete in Duplicate) � qq -C� <br /> - Date Issued ._-1________________• <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct an install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_ - .X-_--:) ,,K G <br /> Owner's Name--------- � -- ----------------- Phone.................................... <br /> Address...................------e-'- =lex----116 <br /> .. <br /> Contractor's Name--------------- 11�A'.__Y E ---------------------------------------•------•--•-•---------------..-----------_-- Phone . <br /> Installation will serve: Residence D---A-partment House ❑ Comr,iercial ❑ Trailer Court [I Motel ❑ Other ❑ ' <br /> Number of living units: _1----- Number of bedrooms . Number of',baths -_-/- Lot size ------ _._ - -- <br /> - --- <br /> ---•------- --------------- <br /> Water Supply: Public system E] Community system [-] Private�epth To Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff-"Hardpan ❑ <br /> Previous Application Made: (If yes,date---------------- _1 No New Construction: Yes 92"'No ❑ FHANA: 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 nearest well-----------------Distance from foundation....................Material___--------------------__-----_-.---------------. <br /> D=isof <br /> i� No. of compartments-------------------------Size..-•------•--•------------;----Liquid depth-•------------------------Capacity--------------I--•-• <br /> { !_ ield: Distance from nearest well_.--]F'-Distance from foundation__.-.1a..7'...Distance to nearest lot line.--S.1 v <br /> irlri (Afl Number of lines-------------.� ------_----- --Length of each line_....-._.--.--ir�_l___--_--.Wid#h of . <br /> �a Type of filter material - p g j <br /> - io_c4__De th of filter material-------1 ----------Total length <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- <br /> El Number of pits----------------------Lining material---------------------.-Size: Diameter------------------------Depth---.-_--_------_---_---- ---..- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material------------------------------------- <br /> ElSize: 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):___. - - --_.-�-_. r..................................................•----_-• , <br /> ------- -------'--} -- - - --- <br /> ---------------------------------------------------------------------------- ----------------�---------------------2J ----------•----------------------------------------•--'--••-------------------------------- i <br /> •-----------------------•----------••--•--------------------------------------•------------------------------------------------------•------------------------------•---...----....---••-------------------------------- 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 and regulations of the San Joaquin Local Health District. <br /> (Signed)=---7 ---- - - -- -- --- - -----------------------------------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 /> � - t <br /> ' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- -------es.20-0,-------------------------- ----------------------•--------------- DATE---- .'' -- .................. <br /> REVIEWEDBY---------------------------------------------------------------------------------------- DATE--------------- ------------------------••------•--•-------- <br /> BUILDING PERMIT ISSUED -----•------------------•--------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:----------------------------=------------------- -------------------------•------------------------------------------------------------------------------------ <br /> f <br /> ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------•- ------------------­­.......... <br /> FINAL INSPECTION BY:----- - ---- :.?.-•----.C -,-. -- 1,v _ <br /> ":_. Date -- -------- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Am ori can Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Locil,California Monteca,California Tracy,California <br /> ES 9 REVISED 8.59 ZM 5-62 ATLA5 <br />