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FOR OFFICE USE: <br /> -.� "..... ..... ... ..I APPLICATION FOR SANITATION PERMIT Permit No. .. .L_ <br /> ------------- ' = --------------- <br /> (Complete in Duplicate) /J <br /> -------------------- <br /> ----------- This Permit Ex fres 1 Year From Date Issued Data Issued <br /> Application is hereby made to the San Joaquin Local Heal+h 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_----- d s <br /> - --- ---------------------------- ----- -----------•----------------------•---------------- <br /> Owner's Name----- ' <br /> •-- --- - - ----- --- ------ -------------- ---- -------- <br /> Address -------- �� <br /> f -- -- -------• --- Pone--------------=-------•-;--•------- <br /> Contractor's Name------------------------ --•--- -• - ----- Phone----------------------------------- <br /> Installation <br /> ------------------------------- -Installation will serve: Residenceld" Apartment House [: Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:.-/---- Number of bedrooms -4:2-: Number of baths ---/_ Lot size <br /> ---------------- <br /> Water Supply. Public-system Co munity system ❑ Private ❑ Depth to Water Table -S-Q ft. <br /> Character of soil to a depth of 3 feet:r Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Rf Hardpan ❑ <br /> t <br /> Previous Application Made: (If yes,date 3_-_ 4`10) No ❑ New Construction:,Yes [❑ No W FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet,) w <br /> ' r i <br /> pf nk: Distance from nearest well-----------------Distance from foundation---------------------Material _--......._--.. € <br /> ---------------------- <br /> No. of compartments - = ---------Size----------------------i------ Liquid depth------------- ------------Capacity----------------------- <br /> po I Field: Distance from nearest well-------------`.--.Distance from foundation--------------------Distance to nearest lot line---.--.-.-_.---. <br /> Number of lines---.-t-----------------------------Length of each line------------------------------Width of french <br /> Type of filter material-------------------------Depth of filter material------------,--- --..Total length------•--------..,------•-----------__---- <br /> K d e .01 Distance to nearest well. ,__:Dis#ante m fo ndation... <br /> 1�e ' 1Q.._.-_...Distance to nearest lot line--�+0.....-_ <br /> Number of pits_------- ----------Lining,.material--- _, -...._ .Size: Diameter._.. ` <br /> t 3 - -. — 'C._'pepth -7- ----------- W <br /> Cesspool:: Distancekfz-om nearest well--_L.�a.--..__Distance from foundation______--__-_-----..Lining material-------------- <br /> ............................. <br /> ❑ Size: Diameter ----~'--- -------- ----------Depth-----------------------•----------------------------Ligwd Capaat_y gals. <br /> Privy: ,l Distance from nearest weli.-- ----- -----------------Distance.from.nearest,buiHin <br /> ❑ Distance to nearest lot line.... ........._-.----.._.._____....._____. <br /> Remodeling and/or repairing )describe):----------- ----- -- <br /> -------------------------------------------•----------- S <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, Sta a laws, and rules and regulations:of the San Joaquin Local Health District. <br /> (Si ned <br /> 9 ) --- ; ---- -----(Owner and/or Contractor) r <br /> gY:` � <br /> ----------- <br /> -------(Title)--- l _0 --------------------- - -------- ------ - <br /> --- ---- -- -- -------------------- <br /> (Plot plan,'showing.size of lot, location of system i cation to----.wells,.buildings, etc., can be placed on reverse side). <br /> ' FOR DEPARTMENT USE ONLY`" <br /> APPLICATION ACCEPTED <br /> " BY_. -•-- -------- ----- <br /> --_- - - -=-- -DA7E____-- -- ----- l- ---------------- <br /> - <br /> REVIEWED BY = --------. DATE <br /> BUILDING` PERMIT ISSUED ----------- - DATE <br /> -------- <br /> Alterations and/or recommendation :..._... _ _ i <br /> r - ----- --------- L'" •�-`��> <br /> ,. �� <br /> - --------- ------- <br /> ------------ --------------- <br /> --------------------- -- <br /> ----'------- ---- -------- <br /> --------------------- . <br /> INSPECTION BY:..��------- --- --------- �� --------- <br /> 2- <br /> FINAL, l� Z' G <br /> == Date ----------- <br /> ------- <br /> 7SAN LOCAL HEALTH DISTRICT <br /> )bOf E.Haxalton Ave. 300 Wesf Oak Street i24 Sycamore Street <br /> 205 West 9th street <br /> Stockton,California Lodi,California 4.Manteca,California Tracy,California .. <br /> 95 9 REVISED 8-59 3M 3-'S3 F.p.ra. <br />