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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) 3 <br /> Date Issued <br /> 03,0 <br /> Application is hereby made to the San Joaquin Locai Health District for a permit to constructa d 'r stall or herein described. <br /> This application is made in compliant-e,with County.Ordinance No. 549.i. ' •.� 'J � <br /> JOB ADDRESS AND LOCATION_, - q_- -�--' ---� � - - <br /> Owner's Name--------- <br /> . = P c--•-- --• - :� - ------ -•--------------- •--- Ph , e---...------------------------------- <br /> Address <br /> --------------------- <br /> Address ..... - - �• I�hL� �•�•�31 .. ------ ; <br /> Contractor s Name------------ '" _ o <br /> - ------ Phcine--___ ---------- <br /> Installation will serve: Residence (�Apartment House ❑ Commercial ❑ Trailer' Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms __' Number of baths _f Lot size ______ ',,__Q®_--- ____.______ <br /> Water Supply: Public system ❑ Community system ❑ "Private' Depth to Water Table ft- <br /> a <br /> Character of soil to a depth of 3 feet:;. Sand Gravel 0 Sandy Loam Clay Loam [❑ Clay ❑ Adobe ❑ Hardpan 0 <br /> Previous Application Made: Yes ❑ No tNe! Construction Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or`cesspool.permitted if public;sewer is.available wifhin 200 feet.) <br /> Septic Tank: Distance from nearest well_- �------------Distance fro fund tion�� -.Mate_' I <br /> ---- ------- <br /> .DQ No. of compartments---- ___ r t Size_/A�____________________Liquid depth----- - -:------_._Capacity-:��,0e-- <br /> - —r <br /> Disposal Field: Distance from near�est;weil__ _# _-- g tiop'_�d-?.Distance to nearest lot line�� <br /> nce from <br /> Number of lines _____ <br /> ��---•-- Lenath of each line _�,�___.Width of trerach------.�_�._____________ <br /> Type of filter material - ._____ __Depth of filter material___ ______=_._Total length___-___ -�------------------------'� <br /> ;�.��. . <br /> - founclation-"________________.Distance to,nearest lot line_____-_.---______ <br /> Seepage Pit: Number of ptares! well_T 1._'4 -'Lining material e from ----..Size: Diameter-----------------------.Depth------------• ---------- <br /> � . <br /> Cesspool: Distance f•orri nearest well;__..___-_____Distance from•foundation--------------------Lining material-----------_--------_---------_______. I <br /> ❑ Size: Diameter-------I----------' 1 Depth--------=-------=-----•----------------------------Liquid Capacity-----------------------------gals. <br /> nearest well------------------------------------------------Distance from nearest building----------------------------- <br /> Distance to-n <br /> ---------------Distance`to-n �..w-»-� + ,.� :___—L. <br /> Privy: Distance from �� <br /> Barest lot lire77- _7'_____1 <br /> Remodeling and/or repairing (describe):_ _ _ <br /> - -- <br /> --------------•----••--------------------------------------- _ ' <br /> a-#/ - <br /> -------------------- - <br /> - <br /> -----------------------_-------------_-------- <br /> I hereby certify that I have prepared this application and•that the work will be donein 'accordance with San Joaquin County <br /> ordinances, State laws, and rues and regulafiol. of.o.fhe'San Joaquin Local Health District. Y_ <br /> f t <br /> _.;.. 1 r <br /> Si ned <br /> ( g } - ----------------------- <br /> ---------------------------------- -----------------------(Owner and/or Contractor) <br /> By:-------------- ;-- - --------------- — ------- ---------------------------------(Title)- _ <br /> (Plot plan, showing size of lot, location of system in relation fo'viefls, buildings', efc., can be placed an reverse side). <br /> S <br /> I DEP' RT fNT U5 NLY <br /> APPLICATION ACCEPTED 13Y-- ----- ----- ---•-- � <br /> -•---------- __7------------ DATE----- ---- ---------- -----�--- -- -------- <br /> REVIEWEDBy BY-------•------------------------ - --------------------------- --------------- DATE--------------------------- <br /> ----------------------------------- <br /> $UILDING PERMIT ISSUED------------- <br /> --------------------------------------------------_=------------=-- ------ DATE <br /> Alterations and/or recommendations:----------------------------------------- --------------------------------------­­­­------------------------- ' <br /> --------------------------------------------- <br /> P------------ ---------------- <br /> ------------------------------------------------ ------------------------:-------------------------------------------------------------------- --------------------------------------------•----•---------- ------ <br /> <- <br /> _______________ _ _______________________________________________________________________________________________________________________________________________ y <br /> FINAL INSPECTION BY:. ' Y f - —' =� _ Date.-- . ' <br /> - G- ______________________________________________________________ <br /> SAKJOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California !Manteca, California Tracy, California <br /> ES-9-2M , Revised 1-57 F.P.CO. , <br /> k y <br />