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FOR OFFICE USE <br /> --------------- -------- ------- Permit No. ....... <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------ ----- -- --- ------------ <br /> --------------1---------------------------------------- (Complete in Duplicate) Date Issued <br /> ----- --------------------------------------------- This Permit Expires 1 Year From Date Issued ­----------------- <br /> A <br /> T�plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Is application is made in compliance with County Ordinance N 549 9, <br /> ro e,o o A) - Ince <br /> /0001" exe <br /> 1.. ................................_------------------------­- <br /> JOB ADDRESS AND OCATION.. K . ..... .. ........ <br /> . 4 <br /> Owner's, Name------ <br /> --- ------------------... Phone._.._.. __....................... <br /> - <br /> Address---------------------- ........... .A--- ---- ---------------------------------------------------- <br /> ----------------------------------- <br /> -------- <br /> Contractor's' Name_ -----------------------_ <br /> - ---- Phone <br /> ------------------------I----- <br /> Installation will serve: Residence 2Apartment House E] Comriiercial [:] Trailer Court E] Other ❑ <br /> I t/ <br /> Number of living units: ---)--- Number of bedrooms 3--- Number of baths _--I--- Lot size -- ---------------------------------------- <br /> __ <br /> Wafer Supply: Public system Q'--Community system [3 Private [] Depth TO Water Table4 <br /> Character of soil to a depth of 3 feet: Send F <br /> Gravel [] Sandy Loam 0 Clay Loam [j ❑Clay Adobe[&-'Vardpan ❑ <br /> Previous Application Made: (if yes,date---------- --------) No [ij,"New Construction- Yes. o ❑ FHA/VA.. Yes E] No <br /> I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 411 Q� <br /> (No septic�tank or cesspool permitted if public sewer-is available within 200 feet.) <br /> Septic Tp4 Distance from from foundation-/0-...!_MaJ71al--- <br /> No. of compartments- iqu -----------C <br /> --------- --------------Size-------".A_VC7.Lf i ep�k apacity.-rov------- <br /> Dispos I F* Id: Distance from nearest well....."{'__.._Distance <br /> from foundation A*j .....Distance to nearest lot line-- ------- <br /> ---------------- <br /> Number-'of lines-----------2-----------------Length of each line....A- Width of franc <br /> tal length- ------------------------_--- <br /> Type of filter material...YO-C-L--------Depth of filter material-__-C-/-,ff <br /> ................. <br /> Seepage Distance to nearest weil----------------------Distance from foundation!-_................Distance to nearest lot line <br /> Number of pits--4PA------------Lining maferialA,0_G_/r------Size: DiameterES'f/---------Depth------aj-------------- <br /> Cesspool: Distance from nearest well__,-,------------Distance from foundation.--- - Lining material-----------------------------_-_-.._ <br /> material----------------------------------._ <br /> I Size- Diameter---r- - --- ------------ - - --Liquid Capacity - gals. <br /> Privy: Distance from nearest well------------------- L <br /> ---------------------- ------Distance from, nearest building------.---------.._---.-.___--_--..--_--. <br /> -- ------------ ---------- <br /> 13 Distance to nearest lot line-----------------------•---------------- --------------- ------------------------------------------------- <br /> - <br /> Remodeling and/or repairing (describe):---------- ------ _ _------------- <br /> - ___—------- --------- - -------------------------------------------- <br /> ---------------------------------------------- ------------------------------------------------------- ------- -- --------- --------------:------ <br /> ----------------------------------- ------------------------------------------------------------------------------------------------9------------------------ --------•--------------------------- <br /> ---------I----------------I- . ot <br /> -----------------------------------il------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> - <br /> I hereby certif I have pre' this application and that the work will be done in coIcrdance with San Joaquin County <br /> ordinances, State la a rules a re la .* ns of the San Joaquin Local Health District. <br /> ----------- <br /> (Signed)............ -- -------- -- ---------- ----- ------------------------------- ------------------------- (Owner and/or Contractor) <br /> ------------------------- - ------------ ----- - - ------------------------------.(Title],--- - 91Z4_h�__...... ------------ <br /> (Plot plan, showing size of location of system in relation to we S, buildings,-Vtc„-can,69 placed an reverse side). <br /> ,FQR DEPARyENTjUSE ONLY <br /> APPLICATION ACCEPTED B - -- ------ ------------- -------------- DATE----- -- - - ----------------------- <br /> - --- ---------- <br /> REVIEWED BY--------- ---------------- -------- --------------------- ......... DATE----------------- --------------------------------------- <br /> ----------------- - ' <br /> BUILDING PERMIT ISSUED-------------- 0 ----------- -- - - --- ------------------------------------ -------------------- <br /> Alter im lir ----------- ------------------ <br /> ---�'Cr- ---- ----- <br /> ------------------ - - <br /> -- ----------- <br /> .......(,-, -- <br /> ... <br /> ..... <br /> ------------------------------------ --------- -------------- - -----------...................... -----------------------­-- <br /> ---------------------------------------------------------- ----------- -------- ----------- --------------------•-------------- •-----_--------.w <br /> FINAL INSPECTION BY E............. ---------------m­------------------ <br /> -------------------------------- Date----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak S7* 124 Sycamore Street 205 West 9th Streat <br /> Stockton,California Lodi,California, Mtlttsi.aCrillfornia Tracy California <br /> -L <br /> 9 REVISED 5-59 2M 5.62 ATLAS <br />