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OR FFICE USE: <br /> -.2 <br /> -------- APPLICATION FOR SANITATION PERMIT Permit No. _13.. <br />-------------------------------------------------------- <br />------------------ (C6mplete-lin'Duplicate) <br /> ------------------------- ?' <br /> .......... ------ Date Issued. <br /> This Permit Expires 1 Year From Date Issued ......... <br /> Application is hereby 'Made to the San Joaquin Local Health District for a permit to construct and install the work he'r#ein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> ---------- <br /> JOB ADDRESS AND <br /> LO. ATION ----------------- I.. ......... <br /> F <br /> -9il <br /> Owner's Name----------- ....... io- -------- ------------- ---- ------- ----------------------------------------- --- Phone----------------------------------- <br /> ------------ <br /> Address. -------------------------------------------------- <br /> ............ .. .... WA -------------- ------I.......... ------------ <br /> ------- ---- Phone.&.&----- <br /> Contractor's Name----------t - ------ ------- ----- <br /> Installation will serve: dsidence Apartment House F] Commercial El Trailer Court [-I Motel [3 Other 0 <br /> _%� /41�4 <br /> Number of living units: _____V Number of bedrooms __Number of aths ____1, Lot size ------------ ------- <br /> Water Supply: Public system [] Community system [_1 Private Depth TO Water Table ft. <br /> Charaicter of soil to a depth of 3 feet: Sand [:] Gravel [:] pSa 4 Loam E] Clay Loam 0 Clay El Adobe 8-lHardpan C] <br /> Previous Application Made: (if yes,date--------------- ---) No New Construction: Yes No E] FHA/VA. Yes [] No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> I(No se tic tank or cesspool permitted if public s9wer is availa6lewithin'200 feet.) <br /> ...Distance f7rom-fou­_n6__dati_ /0-------- -Material ............... <br /> Septic Tank: Distance from nearest well..1 le 01_ --.'' I— - <br /> No. of compartments------------71?77n-------Size-, ---Liquid clepth,�� _�Ii—----------Capacity.....aT------ . <br /> 4LA <br /> Disposal Field: Distance from nearest well-___:5­0_..Distance from founclation-__40.........Distance to nearest lot line......5....... <br /> J� <br /> Number of lines-- Length of each-line------- ...... ......zT�idth of trench........2 <br /> ---------- --- ---------- <br /> ___14P JTotal -------------------- n <br /> Type of filter mate . ji --- -----Depth of filter material <br /> Seepage Pit: Distance to nearest well_--- - <br /> Distance from foundation--------- to'n'earest lot line_________________ <br /> 4 Number of pits----------------------Lining material---------k------------ Size: Diarneter_,_-!'-,----1-'(----,D'e --- ---------------------------- <br /> Cessp6ol: Distance from nearest well_________________Distance fromO"ound'a'-t"to-n.'..-'-i.-__-____.Lining material__._________'_-__-___.t----------- <br /> 1771 Size: Diameter_..------- ----------------------_Depth----------------­'­-------------- Liquid Capaci ---gals. <br /> ty------------------------- <br /> Distance from nearest well-----------------------------------------------!-,Distan "from nearest-l3u"i]a7,n_j'V_77=------- ------------ <br /> Privy: . ce,� %%V.) I <br /> 171, Distance to nearest 0 line----------------------------------------------111-11V---VP.....I............I <br /> ................ ---------------- <br /> -P <br /> Remodeling and/or repairing (describe):-------------------------------------------------_--------------------------------------------------------------------------------?'`f----------- <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Y7--------------- <br /> -------------------------------------------I------------------------------------------------------------------------ -------------------------------------------------------------------------------------I------------------- <br /> -------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I <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 rules and regulations of the San Joaquin Local Health District. <br /> Ile, =----------------------------(Owner and/or Contractor) <br /> - - Ile,(Signed)........ --- - - -- ------ --- ----- --------- - 4 <br /> --------------------Iritle)------------- ------------------------- ------------------ <br /> By:_.:.... .. <br /> (Plot plan, showing size of lot, locatbn of system in relation to Wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTM64T,,ySE ONLY <br /> APPLICATION-,ACCEPTED BY-------j:� ------------------------ ------------------------ --- <br /> ---------------- DATE------3nZs 5 -------------------- <br /> REVIEWED <br /> -------------- <br /> REVIEWEDBY------------------------------------------------------------------------------- ---------------------------------------------- DATE-------••-••.------­------ ......*------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------- ----------------------------------------------------- DATE.---------_--..---- ---11----------------------------- <br /> Alterations and/or recommendations:__._._..__________________ ---------------------------------------------------------------------------------I.............. -----------.............. <br /> ..............i?- -- - ---------- ------- ------------ -------------------------------- -------------------- ------------------ -------------------------------------- <br /> ------------------?, € ---------------------------------------------------- <br /> Y <br /> .......!K ...... 67 N <br /> ------------------------ -------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ <br /> ----------------------------- ---------------------------------------------------------- -------------­------------------------------------------------------------------------------------------------------- <br /> -------------------- Da ----------1------------------------- <br /> FINAL INSPECTION BY:....____.__e.-.e te----------- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 5-59 2M 5-62 ATLAS <br />