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FOR OFFIC USE: <br /> ----- ----------------------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. -.1..._ ._....... <br /> -------------------------------------------------------- (Complete in Duplicate) <br /> ----------------- This Permit Expires I Year From Date Issued Date Issued ____�__ ��� - <br /> � <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 No. 549. <br /> JOB ADDRESS AND LOCATION....$-51...W.---5th.---S_tseet---------- ---Sin-ekto_n------------------------------- ------------------------------ <br /> Owner's Name--------------------------------- ')~lilli � .Qx1 r.t�tic�...Go------------------------------ ------ Phone----50--2071-5-------- <br /> Address p------ ------BOX---6 7 att .------------------------------------------ -- --- <br /> Contractor's NameTbe--- AY--- N GHT_.n'�• Z`� V�.-----------------• ------------------------------------------------ Phone....KQ---- .841------- <br /> Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..___ Number of bedrooms ----2- Number of baths _1___ Lot size .-95.t--_X- Q-1-______________._____-_____.____ <br /> Water Supply: Public system XK Community system ❑ Private ❑ Depth to Water Table ----3,5ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yesla' No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r - <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest welINQnB__-_-Distance from foundation___l0�_______-Material-----L''__.0---Brick------------------ <br /> xxNo. of compartments------2__--------- _ Liquid depth-,51!?--------------- Capacity___---Size-__5�jrt tt 11 ----Ca aci _ <br /> bb - <br /> -- --- ----- <br /> Field: Distance from nearest well...N-01le---Distance romkouenPastion___10 _______Distance to nearest lot line-_5!.......... <br /> Disposal <br /> Im Number of lines------3--------------------------Length of each line----- ___-t-_ tt Width of trench __---__24"...______-_.___ <br /> Type of filter material__+$__e-p_t_C_--RkDepth of filter material____._1�_________Total length------ -a <br /> Seepage Pit: Distance to nearest well.NOne_________Distance from foundation------1 1-;.Distance to nearest lot line_____-5_i_------ <br /> X1 Number of pits.-------1------------Lining material.-_RQck--------Size: Diameter---,.33............Depth----------2.5_................. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> E-1 <br /> -_-_____--_________________________❑ a, Size: Diameter-------------------------------------Depth-----I------------------------------------------------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):------------------------------------------------------------------------------------------------ ---_----•-•-----------------------------------------•--• f <br /> ---•-----•............. --------------------------•------------------••--•--•------------------•--------------------------------------------------------------------------------------------------------------- <br /> t <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) The DAY & N1Q1iT--$ T- SVC.,----------------------------- ------ Contractor <br /> -- Title------------------------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------- - <br /> _ i <br /> --------- --- ----------------------------------------------- -! ---------------- <br /> =-----------------•----------- DATE-------- - ---�'-� ---- - <br /> REVIEWED BY------------------------------------------- <br /> ---------------------------------------------------- - -------•--- DATE------------- - <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------•-------------------------------------------- <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------ -------•-------------------- <br /> ------------------------------------------------------•------------------------------------------------------------------------------------•--•------•----•-•-•--•-•---------------•-------------------------------------•- <br /> FINAL INSPECTION $Y:. ---------• --------------- Date _. 2 -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stocktonr California Lodi,California Manteca,California Tracy,California <br /> E6-9 REVISED S-$A F,p.DD.2M 6-60 <br />