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7FR OFFICE USE: <br /> A- <br /> ....................... <br /> --------- --- --I //" <br /> ------------ APPLICATION FOR SANITATION PERMIT Permit No. <br /> .............. <br /> -- ----------------------------- ------------------------ (Complete in Duplicate) <br /> -----------------------------=----------------------._-- This Permit Expires 1 Year From Date Issued <br /> Date Issued --------- <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 /> JOB ADDRESS AND LOCATION-­14ir f ty---- - -------- r---------------------------------------- <br /> Owner's Name--Owner's Name-- --- ------ - -------------- -------------- ------------------------------- Phone----------------------- ------------ <br /> Address---------------------- am- A <br /> ---------- ----------------------------------------------------------­­----­-­-----I----------------------------------- <br /> A ---------------------- <br /> % Phone----------------------------------- <br /> Contractor's Name_----_ <br /> ------------------3---------------------------------------------------------------------------------------------------­ <br /> installation will serve: Residence &"`Apartment Hous.e 0 Commercial E] Trailer Court 0 Motel [I Other ❑ <br /> Number of living units: __-I---_ Number of bedrooms _1 Number 0 aths Lot- size 9 ----------------------------- <br /> Water Supply: Public system E] Community system El Private Depth to Water Table ft. I'. <br /> Character of soil to a depth of 3 feet: Sand (] Gravel E] S ndy Loam 0 Clay Loam El lay 0 Adobe ErHardpan0 <br /> Previous Application Made: (if yes,date._-.._--_-------- ----) No New Construction: Yes ��No El FHA/VA: Yes F1 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet <br /> S e t' T fik: Distance from nearest we1L_-0__------Distance from foundation- ____.____._.Ma <br /> ' <br /> pka No. of comparfments_____.;2--- -------------size--- -------Liqui-d__depth.-.-_-4.-_-4--- Ca.p-a.cif-y ---2P- ---------------tA, <br /> Disposal field: Distance from nearest well__+-rq-------Distance from founclationA--------------Distance to nearest lot line---_------------ <br /> Number of lines------ig�-----------------------Length of each line----,7-,5----------------Width of french----7��_Jf------------------------- <br /> Type of filter maferiai--___710_.C_A------Depth of`filter material---/$--------------Total length------1J.—P------------------------- X, <br /> Seepaqa-Pif: Distance to nearest well-10------------Distanqprn foundation----hP-----------Distance to nearest lot line- <br /> ir ------- ------- <br /> Number of pits-1—--------------Lining material____f----- <br /> #.(_k------Size: Diameter___,-3,5__"_..----Depth------------2_5_�............ ..P <br /> 7 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation - ----------------Lining material_---..._..---_-.__-_-_-_--_----_-----. <br /> 0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-- -----------------------gals. <br /> Privy-, Distance from nearest well----_---- -------------------------------------Distance from nearest,building----------------------------- <br /> -- - - -- <br /> ElDistance to nearest lot line------------------------- -------------------------------------------------------------------------------------------------------------------��_Z <br /> Remodeling and/or repairing (describe):------- --------- ------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ <br /> I <br /> ------ -I hereby certify that I have prepared o this appli atiand that the work will be done in accordance with San Joaquin County <br /> to <br /> ordinances, State laws, and rules and regulations +h San Joaquin Local Health District., <br /> (Signed)-------------------------------------------------------------------- - ---- - -- --------- ----------*---------------------------------------- --------(Owner and/or. Cont racf or) <br /> By:--------------------------------------------- -------------------------- -------------------- -----------------------(Title)-----=---- ------------------- -------------- - ---------- <br /> V <br /> (Plot plan, showing size of lot, locatio system.in.relation.to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----.All------ - - _X--- -------------•----------------------------------------------------------------------- DATE------ ------- <br /> REVIEWEDBY-------------------------------------------- ------------ ----------------------- ---------------------------------------- DATE------------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------- ------------------ --------------------------- DATE--------------------------------------------N:--------------- <br /> Alterations and/or recommendations:--rn menda f ions:-- ------ <br /> .......... <br /> - ------------------------ -------- <br /> ------------------ --- ---- ---------- ------------------------- ------ ------------------------------- <br /> ....... <br /> ----------- -------- --------------- - --------- --- ------ --------------------- <br /> --------------------- ------------------------------------ <br /> ------------ ----------------------------------------- ----- ------ ------------------------------------------------------------------------------ - -------------- ----------------- <br /> ----------------- ------- ------­­------------------------------------------------------------ -------------- ------------------------------ ------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:..--/ ------X------- --- - ---- ------ D -- ------ -------- <br /> ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hoseltan Avo, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodir California Manteca,California Tracy, California <br /> ES 9 REVISED 8-59 3M 3-'63 F.P.120, <br />