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FOR <br /> 0 R IF CE USE: Ar <br /> - - - -------- <br /> -------- ---- ""-"------------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. <br /> lJr <br /> ------------------------ (Complete in Duplicate) :.Z <br /> ------------ --- --- --- This Permit ExPires I Year From Date Issued Date Issued --- <br /> Al5plication 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 <br /> A LOCATION.-.-.- .... <br /> Owner's Name----- --------­------ <br /> - -------------------------- <br /> PT ,_tl� <br /> Address - ------------ --- Phone. <br /> ----------------- /_Z---- -------t_ <br /> Contractor's Na ------4.............. <br /> Im e G3 X !�v <br /> - ---------------------------- <br /> Installation will serve: Residence ----------------------I---------❑*---------- Phon . . ......45� <br /> J6 Apartment House E] Commercial El Trailer Court [] Motel 0 Other <br /> ❑ <br /> Number of living units: __/_ Number of bedrooms of baths Or <br /> Lot size <br /> Water Supply: public system ...... <br /> 2--61-mmunity system 0 Private 0 Depth To Water Tabl%3 - <br /> Character of soil to a depth of 3 feet: Sand El Gravel [j Sandy Loam E] ClaLoam ft. <br /> Previous Application Made: (If yes,date E] Clay [- Adobe Hardpan 0 <br /> 0' <br /> -------- ---- y No New Construction: Yes Ej No ' FHA Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ <br /> (No Septic tank Or cesspool permitted if public sewer is available within 200 feet.) <br /> Sep Distance from nearest well-----------------Distance from foundation--------------------Material.------- <br /> No. of compartments-------------------------Size------- ------- ................................ <br /> D, _Liquid clep�h--------------------------Capacity----------------------stance ---------------------- <br /> os Distance from nearest wefl-jqrfoundation____-`--_-_ r <br /> Number of lines____-__!`___ Distance from -------Distance to nearest lot line-----S.r <br /> 4 061 . ------ ----Length _�_j--------LWidth of trench ------- <br /> d, Iof each line----4_42- <br /> Type of filter materia Id, Depth of filter material--le. <br /> Seepacie Pit: Distance to neare' 7--------------Total length------------------ -------- <br /> 11 ­_ - Ja­........ <br /> &_ Distance fro foundation 01 . <br /> Number of pits__- <br /> ................ 'K� -----/ ..,_Distarice to nearest lot fine <br /> Lining material. e----- <br /> - ---------Size: Diameter- -- ----Depth------ <br /> Cesspool: Distance from nearest well-----------------Distance fro foundation-----.______•----- ----------------- <br /> F1Size: Diameter"----=--•-----------------------------Depth------------ <br /> iameter--------------------------------------Depth------------------- -1ining material-------------------------------------- <br /> Privy: Distance from nearest well____-""_-.-"-""_-.--_"""_---- ---------------------------------Liquid Capacity- ---------------------.-gals. • <br /> ❑ <br /> Distance to nearest lot fine_____________"_- Distance from nearest building---------I-------------- <br /> ---------------- <br /> -------------------------------------------------------I---------------------------------------------------------- ---------- <br /> ARPmodeling and/or re Wes ribe): N <br /> g ---- -- -- ----- •- -- <br /> j- _-_L.__ff repair" -------- - -4-A -------- <br /> 7 ------ ---- --- ;�� <br /> -----------U.-I-------------------------------------------------- - ------ -- - ------- -------------- ----------- ---------------------------------------------------- <br /> -------I------------------------------------------ --------I--- - -- ---- ---- ---------------------------- <br /> I hereby certify that -------- -------------------- -------- ---------I---- ----- <br /> nces <br /> ,�51 ce with San Joaquin County <br /> ordinances, S a laws, and rules and 'regulations of the San Joaquin Local Health District. ----*------------------------------------ <br /> es, ork will be done in accordance I have prepared this application and that the -- ------------ --------- <br /> (SignI <br /> ed)---- ----------- <br /> By:.............................................. - --------------------------------------------------------- Contractor) <br /> (Plot plan, showing size of lot, loc&+io*----------------*-------- --- ---------- - ---- - -------------------------(Tif lei ---------------&'---------- <br /> n of system elation wells,to wells. Q <br /> dings, etc., can be placed on reverse side). <br /> FORD RTM&:NT USE ONLY <br /> APPLICATION ACCEPTED BY____-_______---- ---. <br /> REVIEWED BY --------­--------------­----------- DATE---- <br /> BUILDING PERMIT ISSUED-------- <br /> ----------------------------------------------------------------------------------------------- DATE--------------..._....._ <br /> - ----------------------------------------------------—-------------_---------------------- DATE ............................... <br /> Alterations and/or recommendations:_-_ ---------------------•----- ............................... .. <br /> ------ ---------------------------- <br /> 457--- ------- ------*--------*---------------- <br /> ------------------------------------ ..........:-- ------ <br /> -------------------------------------------------------------------...... <br /> ----------------------- •---•--- ------- ---------------------------- -------------------------------- <br /> -------------*----------------------------------------- <br /> -------------- <br /> -----­---------------------- ------------------------------ --------------------------------------- ------------------------------------------------------------------------------------------------------ <br /> ------------------------------------- -------------------------- -------------------------------------------- ----------------------------------------- ------------------------........... <br /> FINAL INSPECTION BY:..-.-"_----- t2r__ <br /> ------------------------ ---- ------- Date------- ---9r' <br /> "I* , ----- --------------- -------------- <br /> 130 South American Street SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 Well Oak Sirest 124 Sycarnere Street <br /> Stockton,CaliFornia Led[,California05 West 91h Street.011fornia Manteca,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS TrOCY,California <br />