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OR OF l E USE: <br /> •� r <br /> �/ / --___- -f --- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------- - ---------------------- -------- (Complete in Duplicate) <br />----------------------------------------_ .------------- 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 No. 549. <br /> JOB ADDRESS AND LOCATION-- -- ------ - --- -- --- - --- -------------(1G _. -! •�T- �(��1 <br /> � '� <br /> Owner's Name....- l ---- --- -- -------- ------­---------- <br /> ---- ------� - -- ------------------------------------------------------- Phone------------------------------------ <br /> X <br /> Oo­ <br /> Contractor's <br /> ---'; --�-------------------•------------•----.......----------------------------------------------•-------------•... <br /> �?Name-----s�E�/-'"� --- = ------_--_-_ Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑] Trailer Court ❑ Motel ❑ Other ❑ � <br /> Number of living units: ___ __. Number of bedrooms _3__ Number of baths -/.... Lot size ..........................:.... <br /> Water Supply: Public system ❑ Community system ❑ Private�pth to Water Table-l_0 ft. <br /> Character of soil to a depth of 3 feet: _Sand ❑ Gravel ❑ Sa y Loam El Clay Loam Clay ❑ Adobe❑ Hardpan ®_ <br /> ED <br /> Previous Application Made: (if yes,date--------------------) No New Construction: 1'es No ❑ FHA/VA: Yes �o <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T k: Distance from nearest well..-,5---- ___..Distance from foun ation___to!.._..__.Material_______f--_ .-.1...... <br /> No. of compartments--------2—-------------Size------_-�. Ak _ _-_Liquid depth...... Capacity... <br /> �� ... <br /> Disposal Field: Distance from nearest well-�S(9......Distance from foundation---------r. ..__.Distance to nearest lot line_____._... <br /> ®� Number of lines._..;__________________ Length of each line----30------------------Width of trench.--�-�-`- <br /> ----------- <br /> ._..... <br /> Type of filter material.._�bS, -------Depth of filter material__ _ _'`'_______._Total length-------5, �?___------------_....... <br /> ___"" <br /> Seepage •it: +t Distance to nearest well_-_L _____________Distance om foundation.-�a-------------D?istant a to nearest lot line_ ?__......... <br /> f Number of pits_____________________Lining material--i --- <br /> A- <br /> Cesspool: <br /> /�-___Size: Diameter----rtil.r •_ ______.Depth-____s: __.1_...____..._ <br /> i-- .4, <br /> Cesspool: ! '�t Distance.from'nearest well-------------_...Distance from foundation-------------------.Lining material............................_._.._..__ <br /> ❑ Size:,iDiamefer-------------------------------------Depth-------------------------------------------- ----Liquid Capacity-------•----•---------------gals. I <br /> �. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---..---------------._....------------ --- <br /> ❑ - Distance to nearest lot line----------------------------------------------------------------------- -•--•-----------•--------•---•------------•----•--•------------------- <br /> Remodeling and/or repairing (describe)----------------------------------------------- ........--------------------------------------- ----•-•-----------•---------------•--•---•---•---••--• <br /> ----------------------•---------•----------.:.------------------_.---•----•-----...--------------------•------------ <br /> P P --Aat* <br /> ------ <br /> I herebycertifythat I have prepared than that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulaa Joaquin ocal Health District. <br /> ---------------- ----- ----------------------------------------------------•--- Owner and or Contractor{Signed}--••-•-•-----------------------•- ( / ) <br /> BY=-5 .-•--•------------------------- ------- ------------- --•----•------------------ (Title} - . <br /> (Plot plan, showing size of lot, location of System in relation tow Is, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - J --------------- DATE.... --- 1'? <br /> ----- ------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------.---- •---------------- DATE-•-•------.._..--------.----------------------------------- <br /> D -- •• <br /> G-;PERMIT ISSUED----------------------------------------------- ---------•--------------------------- -•-- --------- DATE.--- ---.._._.--- <br /> �- <br /> r •------ ----------------------------- ---------------------------------I——..-•- --------•----•---•-- ----------------------------- <br /> -- <br /> --------------------------------------------------------------------------------------- <br /> --------------------------------- -- --- ----- . ------------- <br /> - - ------------------------ <br /> FINAL INSPECTION BY:---- Date__..- r ":. <br /> xt` SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 134 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS , <br /> I f <br />