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FOR OFFICE USE: <br /> - /47. <br /> e< ---------------, -�- APPLICATION FOR SANITATION PERMIT Permit No. _,�j._. r.� <br /> ----------------------­-- --- ------------- (Complete in Duplicate) <br /> .................. This Permit Expires I Year From Date Issued Date Issued <br />- ------------------------------- - ,fir <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrict and install the work-herein described. <br /> This application is made in compliance with County Orcin nce o. 549. L <br /> ZIdSD -�r LaJ•4 S? /�' J •- <br /> JOB ADDRESS AND LOCATION % ° .............. <br /> ----------------- •-------------------------- -�-----`..�S <br /> �y <br /> Owner's Name ------------------------------ ------ Phone-----------------....... ---------- <br /> � <br /> . ......-•----••• - -..----•-•------------•---.--- <br /> Address________ <br /> Contractor's Name-----------------`Y9W - ----------------------- Phone..................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .___ Number of bedrooms__ Number of baths ---Z. Lot size <br /> Water Supply: Public system gKitommunity system ❑ Private ❑ Depth To Water Table,40 It. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2_119ardpan ❑ <br /> Previous Application Made: llf yes,date----------------_-) No `New Construction: Yes ❑ No Ea.-`FHA/VA: Yes �o ❑ <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 well__' lP _ ..Distance from foundation___________________Material----------------_------------------------------- <br /> �F �,.� No. of compartments--------•-----------------Size--------•-----------------------Liquid depth---------- --- - -------•-Capacity-----_------------- <br /> i <br /> Disposal Feld: - Distance from nearest well_______ ________Distance from foundatio _j�______.....Distance to nearest lot <br /> Number of lines--------/-__ --___ _Length of each line_____�!_�___`!_-_-Width of trench__X__ _______________________ I" <br /> 7 Type of filter materia, Depth of filter material-----A 9 <br /> --- ----•--Total length ;7.;:F ------------------------ <br /> � <br /> Seepage t: Distance to nearest well-___:!^ -------Distance from <br /> foundation---f�_ __.. <br /> .Distance to nearest lot line--- UN <br /> Number of _-----LiningmateriaSize: Diameter__ <br /> -----Depth--94;- _______________ <br /> Cesspool: Distance from nearest well-----------------Distance from foun ion...-_.--------------Lining material-..---------------------------------- <br /> ❑ Size: Diameter-------------------------------------Depth----- •----------------------._Liquid Capacity.. gals. <br /> Privy: Distance from nearest well----------------------------------------- - ---_Distance from nearest building-----_________________________-__.____-_- r <br /> ❑ Distance to nearest lot line---------------------- ---- ---------------------------------------- <br /> ----------------------------•---------------------- <br /> Remodeling and/or repairing (describe):----------------- ll 2 '�C --- -•--- ----•--------------------------•--•-•---------------•- <br /> ------------•.---••-------------------------------------------•--------------------•---•--•-----------•----------- ---------------------------- ------------------------------------------------------------------------ <br /> ----------I----------------------------------------------------•----------------------------------------------•-•---------•---------------------•------------------------------------------------------•-------------------- <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, State laws, and rul s and regulations of the San Joaquin Local Health District. <br /> (Signed)-------------------- ( wdjor Contractorl <br /> By:---------------------------------.------------------ --- - '------{Title lam' ----...... <br /> -- - - - -------- --- --- <br /> (Plot plan, showing size of lot, location of system i lation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_, I---------------------------11-----­---------------- DATE----/-�---t6-----4�3------------------- <br /> REVIEWEDBY ------------------------------------------ DATE------ ---------•-••------------------•--------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------••-•------------ DATE--------------- ----.....------------------------------------ <br /> Alterations_and or recommen tions:---------- ----+-------- -----------------•-•-- -- - ------- ---- --- ----- <br /> _. <br /> - -- - ------- <br /> ' * <br /> - ------------------------------------------------­------ --------------- 5L............ ---------------r---------------------------------------------) <br /> FINAL INSPECTION BY: r Date_...k- -- -r- 7. G-�----------------- ------------ <br /> SAN�JOAQL ILOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wed Oak Srreet 134 Sycamore Street 205 Wort 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62. ATLAS <br />