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NXUri- U USt: <br /> ------------------------------ -•---- ------------------- ' <br /> ..............._.___---__..__..__.._-- --------------- APPLICATION FOR SANITATION PERMIT Permit No. _1_0(r' <br /> -------------------------------------------------------- (Complete in Duplicate) <br /> ------------- This Permit Ex fres 1 Year From Date Issued Date Issued .........3 .. <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 compliance with County Ordinance No. 549. <br /> 4 <br /> JOB ADDRESS AND. ATION.--- .. <br /> . ,. .,. . <br /> Owners Name:f._..; - ----- . ` - - "". " `'�= "` `- ,Phone- '. <br /> - --- --• ------ <br /> ---- <br /> Address.......___._ -- <br /> Contractor's Name.. - ----------------------------------------- Phone................._.......... <br /> Installation will serve: Residence XApartment House ❑ Comm ial E] Trailer Court [-] Motel [3Other E] i <br /> Number of living,units: ___ Number of bedrooms.X--- Number''of baths ___71 Lot size .................... <br /> Water Supply: Public system ❑ Community system Private Depth to Water Table &_p ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel 1 r.ffi Sandy roam Clay Loam [3Clay E] Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) #'I�o �.�ti New construction: Yes 0 No ❑ FHA/VA: Yes E] No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ;) <br /> (No septic tank or cesspool prmit#ed if public s wer is available within 200 feet.) A <br /> Septic Tank: Distance from nearest well-200.....Distance"r (n found ign__._./b--...__.M aria] .. ....... ......... <br /> -jNo. of com artments_ f w <br /> p -------------------SIz 'r - i uid depth Ca aci <br /> rr�� q P P tY s"LC9€3 <br /> Disposal Field: Distance from nearest well—Aft-, -.rDistance from foundatio 2&___.......Distance to nearest lot line.2110...... <br /> Number of lines_:_'_. _ __Len th of each line...��________________Width of trench..... --------------------- <br /> p <br /> t e <br /> --------------------- <br /> ;Type of filter material___�__ Dep+h of filter material____../.g_ _______Total length---d#��..._.'_ <br /> ------------• --•- <br /> See a Pit: Dis#ante to nearest well ; <br /> p g . ______Distance fro fou ti n ....'70_._..Distance to nearest lot,line....17,0..._._ <br /> Number of pits---�-.___.___.__Lining material}�1^. _ --------De th �' A <br /> P <br /> Cesspool: Distance from nearest well------------_-_-Distance from oundation__.___-___---__.Lining material--------------- :.................. <br /> El Size: Diameter----i------•----___--- <br /> ---------- ` ...Depth-------------------------------------------.--.--..-Liquid Capacity............................gals. <br /> Privy:"° Dis#ante from nearest well ______________ __ ___---__--------------Distance from nearest building-----------------------------------...... <br /> ❑ Distance to nearest lot line T <br /> -----------------------------------•-•------ <br /> Remodeling and/or re1pairing (describe):-- - _----- 4v ------------------ -- - ------ ----- _ - <br /> ------------------------------------ <br /> --------- -.(/--------------------- <br /> -------------------------------------------------------------- -------------------------------------------------------------------------------------•---- <br /> - - ------•---------------------------------_-_----------- <br /> I« -. r - # <br /> I hereby certify that I have prepared this application and that the work will be done inliaccordance with San Joaquin County <br /> ordinances, State laws Fan rules and regulat' ns of the San'Jdaquin Local Health District:" <br /> (Signed)..--------------- - - ---- -- -- --------- ------------------•- --- ( fir Contractor) <br /> 13y:.. ---- :-- •----('Title)---- l <br /> (Plot plan, showing size4 f lot, location of system in r Ion to wells, buildings, etc., can be placedon re side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--------------------------------------------------------- -----------•--------------------------- DATE------------ --------------- <br /> REVIEWED BY------------------------------------------------------------------------------ - -- -- ---------------------- <br /> DATE_._....... f...._ --- --------------- <br /> BUILDING PERMIT ISSUED---------------------------------------------------- ---_ -• ----- -----:.........•-_: DATE----....__... <br /> ------------------- <br /> Alterations and/or recommendations----------------------------- ----------------------------------------=------------------=-------••---- ----.... : <br /> ------------------------------------ -­---------------------•-------------•-- ---------------------------------------------------------.............--t------------•------••-•-••-----------------•---•----------.._-... <br /> -------------------------------------------------------------•-------•------•-----------•-----------••--•----------- <br /> FINAL INSPECTION BY;.. ---------- date <br /> SAN JOAQUIN LOCAL HEALTH DIStFUCT <br /> 130 South American Street 300 West Oak Strut 124 Sycamore street 205 West 9th Street <br /> Stockton,California Lodir California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 21A 8-61 ATLAS <br />