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FOR OFFICE US <br /> .. . . ...... <br /> ........... .......... ....... .. APPLICATION FOR SANITATION PERMIT Permit No. <br /> ............................... ...... -- ---- --------- .................. <br /> (Complete in Duplicate) <br /> .. <br /> "•--"- --•-" <br /> .......... ...... ........ Thisfires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit—foconstruct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND OCATION,--.-- <br /> Owner's Name._.-•-- ---- e, Z-- -4-14.......... ................................................................ <br /> -----Z <br /> Address.. ...................... . .... .............................................. Phone <br /> ...................................................................................... <br /> Contractor's Name- <br /> Installation will serve: Residence ------ <br /> ---------'---"'---"'--""---------•------ Phone................... <br /> ET-*Aparfmont House Commercial D Trailer Court ❑ Motel 0 Other 0 <br /> Number of living units: J--- Number of bedroomsl-�-,. Number of bathsyy Lo/t size <br /> I .. ........... ........ ... <br /> Water Supply: Public system D Community system E] Private [R- epth /o Water Table,*7�rft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam C?c•lay LOam E3Cla <br /> Previous Application Made: (If yes,date --- ,, y 0 Adobe,4�<a-,dpan ❑ <br /> -- ) No Oi'-7�lew Construction: t Yes D-�' 10 FHA/VA: Yes [:1 No Ug-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.} <br /> SF tic T Distance from nearest w6ll- <br /> -vST!....Distance from foundation V.............Material_._- <br /> No. of compartments---'-.,-2-—--- -----Size........ - ------- -------- <br /> Disposal Field: Liquid;clep, ..... cdpacity..e-��c <br /> ... ...... <br /> Distance from nearest ---Distance from foundation :20 Distance to nearest lot line-L5.--/ <br /> Number of lines I -___.---._Length <br /> - 1.0 Width of trench. i ........ <br /> --------------------- w ............ <br /> .... ....Length of each line-...,. V <br /> Type of filter material...-:( <br /> --) � -'547epth of filter material --------Total length-...-A <br /> Seepage Pit: Distance to nearest well-:....................Distance from foundation..------------------Distance to nearest lot line------ <br /> Number of pits............. .......Lining material.A�.�' ..'-.Size: Diameter--.. ----Depth----:�� / /-**,--"- <br /> Cesspool: Distance from nearest well..l./ .1 j�------- <br /> ....Distance from foundation._. .........Lining material.... f- - <br /> ❑ Size: Diameter_ -------------------------- - ------ ------- <br /> - --...Depth............................ .......................Liqui Capacity....................... <br /> Privy: Distance from nearest well............................I- id .....gals. <br /> ...................iDistance from nearest building.._........___... <br /> Distance to nearest lot line......................................... i, <br /> --------------------------------------..............•---... .............................. <br /> 04- <br /> --------------- <br /> Remodeling and/or repairing (describe): .... <br /> -----------------------------------------------------------�--t...... -------:�........................... ................................................................... <br /> I-----I............ " ti.7X <br /> ................................................... ..........................................f..................................................................................................... <br /> I <br /> .......................................................... ..............I...............................--------------------------------------------------------------------....................................... <br /> I hereby certify that I have pr6-ared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State lat- a! Lie <br /> I gulations of the San Joaquin Local Health District.' <br /> rule <br /> (Signed}.. ...... ...... A <br /> ---- -- -- ----- --- .. ...... - ------ ...........................-.;................. .....(Owner and/or Contractor) <br /> (Plot plan, showing size of Isystem in relation to wells, buildings, etc., can be place2o'n reverse side). <br /> By:....... .. ................. <br /> .......... -- -- - ------ . ............. .... .....................................Mfle <br /> oca ;o of <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. 41_,.... . ....r`" - -------------------------------------------- DATE-- <br /> ---_-----.-_/`....---...-•-•-................. <br /> REVIEWED BY...................... <br /> -------------------I------------------------------ ----------------------------•----------•--.._....-.. DATE............................ <br /> BUILDING PERMIT ISSUED...................................... .............. DATE.--------- - <br /> .......... <br /> ....... ---------('��........... <br /> Alterations an4/or recormrrienctations:.........eg <br /> ---------- .... .......... <br /> ------ ----x ----- ------- <br /> .......... ...... <br /> ......................... <br /> ................. . .............. ..................... <br /> .......... ------- <br /> ..... ...... -- -r=...... <br /> .............. <br /> ----------- ----------------- --------- --- ---- <br /> ----- ------------- <br /> -j- <br /> a� <br /> e—� <br /> I INAL INSP TIN BY:- <br /> .eol�................................ Dat <br /> -L- '" ALTHSTRICT <br /> 'DI ,- <br /> OCA LOCAL <br /> 130 South American Street 300 West Oak Sort i6f j-/j 124 Sycamore 51,4 205 West 9th Street <br /> Stockton,California Lodi,California Manteca, California Tracy, California <br /> tfi 9 REVISED B-59 2M 5-6t ATLAU <br />