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APPLICATION FOUR SANITATION PERMIT Permit No. <br /> ------------------ ------------------I-------­--------- <br /> ------------------- ------- ------------------------------ <br /> F (Complete in Duplicate) Date Issued <br /> ----- ----------- --------------------------------------- This Permit Expires I Year From 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 comoian-ce,with-C6u-fft-y--Ot-diffdn-tF-N�5-5'491 <br /> -/--1-We.----- ------------------------ <br /> JOB AARESS AND LOCATION_ ----ad ---- <br /> ------------ <br /> Owner's Name---------- --------- e------------------------------------------------------------------------------------------------ Phone--------------------•--••-•-------- <br /> Address------------------------- <br /> ---------------------------------------------------------------_----' -a' <br /> Contractor's Name--.- - Phon <br /> - <br /> Installation will serve: Residence/fL-"Apartment House E] Commercial E] Trailer Court El /Motel [:] Other E] <br /> Number of living.unifs: Nur`hber of bedrooms/7--'-Number of baths _ ____ Lot size ---- f ------ <br /> A. i <br /> Wafer Supply': Public system El I Community system [J� Private El Depth to Wafer Table ft. <br /> Character of soil to a depth of 3 feet. Sand F <br /> Gravel 0 Sandy Loam Eo"Clay Loam El Clay ❑ Adobe [] Hardpan F-] <br /> Previous Application Made: (If yes,date.......... -------- ) No Er" New Construction: Yes P" NojE] FHA/VA: Yes El No M <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) <br /> Septic Tank Distance from,nearest--�7- --------- <br /> ----- ---Distance from fopndai7,,n----/ --------Matb <br /> ell=x 0 4 <br /> ❑ <br /> ----------- <br /> El of compartmerj'fs__1__.�-­J-------Si,e_.11'*X_1a�--------Liquid-depth---. 2"D 0* <br /> -d---------------CapJyte ---------- <br /> Disposal Field: Distance from nearest well'%9_7 -Distance from foundation to nearest lot line-L-5---------- <br /> Length <br /> Number of <br /> E <br /> of each line__X �7-------1311._.Widfh of french---,Y- -------------------- <br /> . I �,-'i, , - L_ -ri . <br /> 0 �00/wype of filter maivial_:_ „,,r�ie1D,pf h 'of filter materia-I__�1)4_1--------Total length--- ---------------------- <br /> 1- —0-10 --- 0) <br /> Seepage Pit::, Distance to nearest weil------------- --------Distance from foundafi3in-------------------Distance to nearest lot line__._______.____-_ <br /> Number of its-------------!..__-___--L-ining maferia Ir............. ........SiZ' <br /> N e: DiaImeter-----------------------Depth-- --- -------------------------- <br /> rie tance from foundation... <br /> Cesspool: Distance from nea stlw4llil__f�d--------Dis/ -----------------Lining.mafer;a4-------------------------------------- <br /> Size: Diameter_ ------ <br /> El --------Depth---------------------- ----------Liquid Capacity----------------------------gals. <br /> i e-11fro' m nearest building------------------------------------------ <br /> Privy: Distance from'nearest -------------------------------------------------D'Stanc <br /> Distance to n8aresf'1otTI-in-e_--­0. ------ --------------------------- -------------------= --------------I------------------------------------------------------- <br /> - - <br /> Remodeling and/or repairing (descrk = -------------------------------------------- ” <br /> . .. ------------------------------------------------------- ------------- <br /> -------------------------------------------------I------------------------------------------------------------------------------------------------------------ -------------------------------------------------------- <br /> ------------------------------------- ---------------- ..................m------------------------------------------4_1 <br /> .. <br /> -------------------------------------------------------------------------------- <br /> ------------------------------------ --------------------------_A_-------------- -----------------------------------------------:------------ <br /> ZL�--------- ;------------------------------------------------------------ <br /> I hereby certify that I have prepared fhis-applicafion and that the work wiVl�ii­done in accordance with San Joaquin County <br /> ordinances, Stat I ws, and rules and regulations-of the San Joaquin Local Health_District. I , <br /> (Signed -----------=t- ---------------------------------------------------------7n:ft�-•------ -----{Owner and/or Contractor) <br /> By -----------------------------------------------------------------------------------------------------------------------------------(Title)_ ... ....... ------ <br /> (Plot plan, showing size of lot, location of sys+em.in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------- --------- ---------------VI-MS------------------------------ DATE <br /> ----------------------- -------- -------------------------------------------- <br /> REVIEWED BY------------------------------------- -- <br /> --------------------------- ---- - ----------7 ---------------------- DATE <br /> - <br /> BUIL.DING <br /> DING PERMIT ISSUED-----•'----------------------------------:----------------------------------------------------------- DATE-------------------------------------------------------------- <br /> Alterations and/or recommendations----------------------- ----!- --------------------------------------------------------------- ---------------------- ------------------------------------ <br /> --------------- - ---------------------------1_2---------------------------------------------------------------------- ------------------------------------------:--------------------------------------------------- <br /> --------------- ------- ------------------------------A-------------------------------------------------------------------------------------------------------------------------------------------- ------------- ----------- <br /> -------------- ------------------------------- --------------------------------------------- --------------------- -------------­------------------------ -------------------- ---------------- <br /> -------------------------------------- ----------------------------- ------- -------------- ------------. ------- 4y <br /> --------------------------------------- -------------------------------- <br /> ' <br /> FINAL INSPkTl ON BY:-------------------- --------- D <br /> ----------- ate-------- x ---------------------------- <br /> ---- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 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 31A 3-'63 F.P.00, <br />