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t-UK UN-K4t U`jt: <br /> tl <br /> /U <br /> t u APPLICATION FOR SANITATION PERMIT Permit No. .�s... . <br /> ­ - - -- (Complete in Duplicate) �,�/ <br /> -- --- -- .--- i This Permit Expires 1 Year From Date Issued Date Issued __.r_----....�._... <br /> Application is hereby In <br /> the San Joaquin Local Healih District for a permit to construct and install the work herein described. <br /> ThA <br /> plic io is made i mpliance► ith County Ordinance No. 549. <br /> �I XJOB A DRESS AN� OC _ /:.� <br /> Owner's Name 1 �- 1�1 ---•- ------------------- Phone.................................... <br /> �!' - - <br /> Address...........................� - ------ s/ - <br /> �q � '/ // q� <br /> Contractor's Name_-------- ` t C Phone l.Zc.fly' <br /> Installation will serve: Residence jo Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] OtherOther <br /> Number of living units: --.- Number of bedrooms 7.. Number of baths f.---- Lot size ..--..- :__ <br /> Water Supply: Public system ❑ Community system [_1 Private Depth To Water Table-- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeo Hardpan ❑ <br /> Previous Application Made: jlf yes,date... _ ) No ❑ New Construction: Yes;Q No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pubilicIsewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-, �.......... <br /> Distanc ,from foundation��`-. M��erial. . /-`__(.L-/.-................_ ._.__ <br /> No. of compartments --Size_��.XS__ - --Liquid depth-_ Ca acit .LiO <br /> P q P. - P Y+� <br /> Disposal Field: Distance from nearest well%5 Distance from foundation -./4.........Distance to nearest lot line_-y.- <br /> Number of lines_-�-..-��-++... Length of each line.�s-.'_�z�___.__.Width of trench..._o�f'` __-.;__--._-. <br /> / Type of filter material--x?y-���:.Depth of filter material_./__9 ........Total length-----_------..---./-d�-G_.1_z i <br /> Seepage Pit: Distance to nearest weII14 '-- __.t_Distance from foundation--/-e....._._.Distance to nearest lot line.�_'S.�_._ <br /> � .i <br /> _ F] N fiber of pits_.-t�-_- -__-Lining material1f_' �._--Size: Diameter_.c3 .._-_....-. Depth--- ................. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__ -.__------.._.Lining material..................................... <br /> ❑ Size: Diameter --------- ----- _.. ---Depth------ - ---- ---- ---------- -------- --- ------Liquid Capacity----_--------------------gals. <br /> Privy: Distance from nearest well------------------------------------- --- - ___-_Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line.- ---------_----------- -- --- --- -----------------------•------------------- ------------------------------------------••--- <br /> Remodelingand/or repairing (describe)------------------- ----•-------------------•--•----------•------------------------------------•--------------------------------•------------------------- <br /> ----------•----------------•------•---------•---•-•------------------------------------•---•----------- --_-•---•--------•--------------------------•-•---------•---------......---•----------------------•-----•--- <br /> --------------•---------------------•••------------------------•--•-----------------•-------------•-----------•---------•------------------•-------•--•-'-------•--------•---•---------------------•-•--•----...........---- <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 A�als, and r sand regulatio1ns of th an Joaquin Local Health District. <br /> (Signed) V - ---- -- ---------- ------•------ ------I <br /> ( ner and/or Contractor) <br /> BB � -(Title)-- ----------------------- <br /> y:----------------------------- ----- ------- -1 <br /> (Plot plan, showing size of lot, location of system in relation o ells, uildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__ ----- - L---------------- DATE-._ __....-. <br /> REVIEWEDBY-------------------------------------------- - - - - -------------------.-------------------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED <br /> � � -------�y------�------ <br /> DATE <br /> �<-----�---------<-,-s- <br /> -�---- ---------- �--------- <br /> AFFerationsand/or recommendaton�__-___ -•...... <br /> G� C <br /> ..... .t---- -`- --------=�/---►1--._-�--�--' -.•.y�-�-* �-:fC, ` �y�`�. Fs�-=`-'�L a-£� '�7 _'_ __ �-t v..G_.L .' . <br /> --------------------------------------------- <br /> -'-- es <br /> - - ----------- '_ / <br /> u �.--------.� --------------------- <br /> .............. <br /> FINAL INSPECTION BY----------- ------- � _ __..-__- Date... <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 /> E5 9 REVISED 8.59 2M 5-62 ATLAS <br />