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yFOR OFFICE USE: ; <br /> - -------------------------- �. <br /> `- �' APPLICATION FOR SANITATION PERMIT Permit No. :..... a <br />-- -------------------- -------- -.-- --------.. x <br /> (ComplAe'in R'.splicate) •� � ,�`'I <br /> " - This Permit Expires.i Year From Dafe Issued <br /> Date Issued <br /> Application is hereby made to theSan`-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. 549. <br /> JOB ADDRESS AND LOCATION---- / -w----- _ = -----=5-%_T-----------------------------• I------ •------------ k <br /> Owner's 'Fame------ � <br /> .Phone----••----------•------------------- <br /> — --------=Address... ------- --- ---------------------- <br /> 1 <br /> ------------------- <br /> � Phone......Contractor's Name----"' '_7F_ <br /> r <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑, <br /> f f <br /> Number of living units: -4—Number of bedrooms _��_ Number of baths __ __ Lot size ��. -_- /�----� -_ ------------------- <br /> Water .Supply: Public system ecommunify system ❑ Private ❑ % Depth to Water Table <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ja''ha�dpan ❑ <br /> Previous Application Made: (If yes,date_._............... l No New Construction: Yes Pq"No ❑ FHA/VA: Yes k�—,No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) <br /> Sep�ti.c,�Ta^nk: Distance from nearest well_...'~------_Distance from f-o�und ion_--f --------Material s` ________________ I <br /> L�? No. of compartments___.___.- A ": `�_Liquid depth�z�y..-... __. P Y <br /> Size .....Ca acit _4- ------ <br /> Disposal Field: Distance-from nearesi"well------.=. ...._Distance from foundatisn.__V--__.---.Distance to nearest lot line_________________ <br /> en th of each line-_ __ _.-_'_. Width of trench�_-�_---_-._ -----------_ <br /> Number of lines_____.a____.�_ g <br /> Type of filter materiaeQY Depth-of filter material_._,f° - -..Total length._3� ___ ------------------------- <br /> A <br /> See age Pit: Distance to nearest well____.-.'�_-.---.--Distance from foundation.__,. ___._.Distance to nearest lot line--- ---___.__ Q <br /> 1 <br /> Y°i�% Number of pits..:f.�_-, _.Lining.material:_/�.f,'e' Size: Diameter . ,. --. Depth %_..._ <br /> -------------------- <br /> Cesspool: Distance from nearest well ------------:.__.Distance from foundation-------------...- Lining material__.._.--_______-._.._...________..._.. f <br /> ❑ r Size: Diameter -------------- -------- Depth ------------------------------ ------Liquid Capacity------------- -------.__gals. k <br /> ............Distance from nearest building-. (' <br /> Privy.. Distance nearest <br /> Distance to ea est lo-t I line <br /> e .. r -------��_;_ :>� T - ------.�----- --- ---------------------------------------- <br /> Remodelinand/or repairing (describe): ---- .... -- �✓ !��--- }��t / `-- = _ <br /> ---------------------------------------- ------------- - ------------------ --------------------------------------------------------------------/------_----------------------------------------------- <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. i <br /> (Signed)_--- ------------------Ap-/_�--_- '. . .�!�'` '' (O Contractor] . <br /> I <br /> Bt� �1 -----------(T tle)-- 4 l��-'-/0p---------------------- -- ----- <br /> By: ------ --- ----__ 1 - L.ter -� <br /> (Piot plan, showing size of lot, location of system i lation to wel s, buildings, etc., can be placed on reverse side). <br /> x <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- . - '----- KX-- ------------- -------------------------------------- DATE---- -- -- --6 8...----- ------- - <br /> REVIEWEDBY------------------------------- ---- ---- ----------------- ------------------ --------------------------------------------.- DATE--------------------- ------------------------- ---------- <br /> BUILDINGPERMIT ISSUED------- ----------- --------------------- --- --- ------------------------ DATE---------------- ----- ----------- ------ <br /> Alterations and/or recommendations:----------.:_*e' l e - ---------- �1�{-----------------•---------------------------------- - <br /> ------ ----------------- ---- <br /> -------------------- ------------------------------------------------ ---------- ------- ------------ -- ` --- -- --------------------- --------------- ---------------- __1- --------------------------- <br /> --------------- -------------------------------------------------------------- ----- -- -------------------------------------- --------- -------------- ------ --------- ------------------------------------------- <br /> f <br /> ...........................__..-.-_-___._...__......_ -------_.--------------------------------------_—_-------------------------------------------..___.----------._._..-...-..-___.___._--- ---------_-_-----.------_-._ <br /> ......................................................._..___._._-.---_._----------------- ------­.............. ... -------------------------- .................__.....---....._---_...__._---._. <br /> FINAL INSPECTION BY:... ._._� Date--- .-r ---- -- <br /> SAN JOAQUIN LOCAL. HEALTH DISTRICT . <br /> x <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> w <br /> Stockton,CalfFat'a1P Lodi, California 4 Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br /> r <br /> T <br />