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FOR OFFICE USE: 4 <br /> ------ --------------------------------------------------- <br /> APPUCATION *OR SANITATION PERMIT Permit No. <br /> ---------------- -------I----------------------- ---------- (Complete in Duplicate) <br /> --- -------------F...... ---------------------------------- ..This Permit Expires 1 Year From Date Issued Date Issued ... <br /> 'Application is hereby made to the San 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 V - <br /> JOB ADDRESS AND L9CATION....3 7: - ---------- - ----- ­-------------- . .. ..............•...................... <br /> Owner s Name--- ---- ---- --- --- ----- hone <br /> Address.... ........... <br /> ---------------- --­--------.. ..................... <br /> P h <br /> Contractor's Name-- --- --- ------ ------ ------_--- Ph <br /> Installation will serve: ResidenceAp merit House'El Cominercial F <br /> Trailer Court [3 Motel Other <br /> Number of living units: _ Number'6*f bedr Number 6f ba ze ......................... <br /> -------- oo s -- ---- bath's --- Lot si <br /> Water Supply: Publicsystem E] i st'e�m Piiva apt aler ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [I Clay Loam 0§-!-�ay'o Adobil:]- Hardpan 0 <br /> Previous Application Made: (If yes,date_..-----_.____.---- No New Construction: Yes g�o E] FHA/VAYes F] No [8� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) <br /> SVtIC T k Distance from nearest well___.__.._______Dista�te from foundation--------_---_--Material---------------- ................---------------- <br /> ------Capacity,-------------- ...... <br /> No. of compartments---------- -- ----_-----Size-,---••---------------:----•-:Licluid depth--- ----------------:, <br /> Feld: Distance from nearest well-----j(r40....Distahce from-foundation____,/..A........Distance to nearest lot line______.'_.... <br /> Number-8f':dines___________-----*#-----------------LertgtC6f each fin6,3__3_-#A4X- _Width of trench----------_--- ------ - <br /> ype -o , i ter,mate -----Depth of filter material____._ length---------- <br /> Seepage Pit: Distance to nearest well---/----------_Distance from fo ----- wWo nearest lot 1ne._',_r------ <br /> er <br /> -Nu�nber Of its------- -------------Lining material' ----Size:-Diamete --------Die <br /> Cesspool. Distance from❑ nearest well----------------`Distance from foundation--------------------Lining materia _.-- -� �N, 'D i <br /> Size. Diameter:__ eiptk----------------------------------------------------Liquid Capacity-------- ------------gals.,., <br /> Privy. Distance from neareit well------------- --------------------------------i"Disfanceftom' nearest building----------------...--.......---------•----• <br /> 4 <br /> Distanceto nearest lot line-'------------ ------- --------------------------- ------------------------•---•-------------------------------------­ --- -------------- <br /> - .......... <br /> Remo or.repairng (d-esc-r-i-be)-:-__ <br /> - -------- - <br /> I------------------------------------------------------------ ----- --------•--•-••--....... ---••---------------- <br /> . . .... <br /> A_ <br /> ------------- <br /> ----------7------------------------------ <br /> --------------------------_------ ------------- ------------------------------------------------------------------ - --------­-------------------------- <br /> I' hr'b certify <br /> that I have pre ad this'ap' licati and at the work will be done in accordance with San Joaquin County <br /> ordinance ate laws, nd ru s a r gulati of'I an quin Local Health District. <br /> (Signed) - ------- -- --- ------------------- -------------- (Ovpner-and/or Contractor) <br /> - ---------------- <br /> -- ----------------------------------------------- <br /> (PlotI s o n of sy' <br /> pan. f I sf er;in" relation to wells, buildings, etc., ca placed on everside]., <br /> FO"EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ •---- r" --------- <br /> -----7 --- A3Z ............... <br /> TE <br /> -REVIEWED BY-------I-------I--------I-------------- : -------------------------------------- ........................ DATE--------------------------------------------------------.-.-.-.- <br /> 7' '... � . L % <br /> BUILDINGPERMIT ISSUED---------------- _20---------------------- ------------- ------------------------------------- DATE--------____------------------------------------ <br /> Alter#iionsd/or recommendations:----------------- ------------------ ----------------------------------------------------------------------------------- ••-----•-•--•-••-•--•------- <br /> --------*-------------- <br /> An 11 , <br /> -- --------;."------------ <br /> FX <br /> ............... --------------------------------------------------------------------- --------------------------------------------------------------------------------­­----------------------------------------- <br /> ---------------------------------------------------------------------------- ----------------------------------------- ...... ------------------------1--------------------------------------------- <br /> -----------------­ <br /> ---------------------------------------------------------------------------------- <br /> -._...•______________________________ ---------- --------------------- ........... ------------------------ ---------------- ------ <br /> Date------- --------- - ? <br /> FINAL INSPECTION BY:----- - ---------- -------------------------------------- <br /> ---- ---------- ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br />