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FOR OFFICE USE: 0 . <br /> ------------------- --------------- 773 <br /> .. ..... <br /> APPLICATION FOR SANITATION PERMIT Permit N0. .....1.. .... <br /> --------------------- ------ {Complete in Duplicate) ssuacl'!,_,� <br /> 'Date I <br /> ----------- This Permit Expires 1 Year From Date Issued 7' <br />—------------ <br /> Application is hereby made to the San Joaquin Local Health District for a perm! it to construct and install the work-herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND --------------------------------------------------------------------- <br /> L <br /> 3FZATION----- PL-------- ------------------------------ <br /> --—--------------------------------- -------------------------------------- -------------- <br /> Owner's Name---_- -- �_*4 ------- ---------- Phone----------------- <br /> Address------ --- ------------------------ ------------- ------------I <br /> -------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name----------- n_A"dv---------------------------------[ <br /> -----------------------­--F------------------- Phone--------- -----------------­ <br /> lnsfalla+;on will serve: Residence P"" Apartment House D Commercial D. Trailer Court D Motel D Other D' <br /> Number of living units:.--_-___ Number of bedrooms _J Number of baths Lot --------------------------------- <br /> Wafer Supply: Public system [Community system [i Pr1v­ate_[j_De`p'th to Wster Table t. <br /> Character of soil to a depth of 3 feet: Sand D Gravel [:] Sandy Loam' D Clay Loam 0 Clay D Adobe 0- Hardpan 0. <br /> Previous Application Made: (jf yes,date_________-___________) No [:] New_Construction: Yes [j No 0 PHA/VA: Ye's El NOD <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank- o Distance from nearest well-___.-____;___Distance from foundation---------------------Materiai------------------------------------------------- <br /> No. of compartments--------------------------Size.-._-..._______ t I..........Liquid clepth---_---------------------Capacity----------------------- <br /> Disposal Field: Disfance',from*nearest well--------------r---�._Distance from fo'un-d6tion---------Z-----------Distance to nearest lot line_________________ <br /> /%'(y�rr f� Number <br /> ine----------------- <br /> Number of lines------ ----- ------------------Length------ - - of each line---,----------------------------Width of trench----.-.._--_-,---------------------- <br /> Type of filter material----- ----- <br /> ----- ----------Depth'of-filfer-mater iia I------------------- ----Total length_______________.________________--,_-__-- <br /> is e <br /> Seepage Pit: -Distance to nearest'well------- ------D, fance'fiom fovmdatDistancto nearest lot line--- <br /> WOO, Number of rnaferia Size: Diameter.-y' , .._..____.Depth---,..-s§ --------------- <br /> Cesspool: Distance from:nearest well----_-----------Distance.from foundation--------------------Uning material------------------------------------- <br /> 0, iSize: Diameter-------------------------- ----------Depth----------------------------- ----------------------Liquid Capacity--------------------------.-gals. <br /> Privy; Distance from nearest well-----------------i----------------------------'--Distance from nearest building__________.______________________--____-_ <br /> ------------ ----------------------------------- <br /> Distance to nea'rest'lot line---, <br /> Remodeling and/or repairing (describe------------------ --_-- <br /> ;r ----�..o ----- "W... <br /> - <br /> ----------------------- <br /> ------------------------------------------------------------------------ -•----..----••---•------------------- <br /> ----------- ------------ ----------- <br /> ---------------------------------- ----------------t--------------------------------------------------------- ------------------------------------ <br /> --------------­----- --------- -------------—-------------------------------------------------------------------------------------------------------------------------------------------------- - <br /> ---------- -1---------- <br /> I hereby certify that I have prepared this application and'fhat the work will be.done in accordance with San Joaquin County <br /> ordinances, State laws, and ruleso!and regulations of +he San Joaquin Loc I Health District. <br /> ggC:m3djCw C <br /> [Signed)------------------------ ------------------------ ---- ontractorl <br /> - <br /> By:------------------------------------------------------------------------ ------- -------------------------(Title)---- .................. --------- <br /> (Plot plan, showing size of lot, location of system in aEion to wells, buildings, etc., can be,placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------C...... --------- --------------—---------------------------------------DATE.. . <br /> --- — -2_ '2— <br /> .. ... ........7-_�e_A-------- ----------------- <br /> REVIEWEDBY---------------------------------------------- ------------------- ---------------------------------------------------------- DATE---------------------_---- ----------------------- ------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------—--------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations: �_ _tp.1--------it,-,.... ----—--------T-A---- _Ls_fTt__K------- ------- <br /> --------------------------------------------------- ----­------------------------w�-----------------------------------------------------------------------------------_----------w--------------- _-_---------- <br /> --------------------------------------------------------------------------------------­-----------------------.----------------------•- •----------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------- ------------ -------------------------------------------- <br /> ------------ ------------------------------------------------------ ----- ------------------------------------------- -------r--------------I-------------------------------- ------ --------------------- <br /> FINALINSPECTION BY:..:_e....... ------------------------------------- Date---- ---------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street A 24 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />\CB-9 REVISED a-59 r.P.CM.2H 6-60 <br />