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................ -.- ----- ................ .ICATION FOR SANITATION PER Permit No. .. <br /> (Complete in Duplicate) Date Issued ..:77/ ' -L <br /> This Permit Expires 1 Year From Date Issued ..7L_ <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 AN CATION ..--,!------ <br /> Owner's Name------ t----------------•------- ---- --•---•---------- Phone.................................... <br /> Address...................................._.. <br /> Contractor's Name-------------- Phone 1lQ- <br /> Installation will serve: Residence [Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: /-_ Number of bedrooms .OZ_. Number of baths _/... Lot size .....YO.x----1.A.7..................... <br /> Water Supply: Public system ❑ Community system ❑ Privatex Depth TO Water Table-5—A ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobew Hardpan ❑ <br /> Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V <br /> t a Distance from nearest well-----------------Distance from foundation--------------------Material................................................. <br /> No. of compartments- ................Size---------------_--------_---•Liquid depth..........................Capacity....................... <br /> If <br /> Disposal geld: Distance from nearest well.,S—d.......Distance from foundation..14--------Distance to nearest lot line...... <br /> Number of lines....... ............ Length of each line......3.E�...............Width of french.... <br /> �I..V------------_.___.... <br /> Type of filter material., :_ De th of filter material_. Total length.....................3_�_........... <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. _ <br /> ❑ Number of pits______________________Lining material---------------------..Size: Diameter.......................Depth................................. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material..................................... <br /> ❑ Size: Diameter--------------------------------------Depth--------- -------------------------------------Liquid Capacity............................ <br /> Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line.............................................................................................................................................. <br /> Remodelingand/or repairing (describe):......---................................................................................................................................................ <br /> -•--••--•-------------•---•---•-•--•-••------•-•----•---•-•---....---•---••---.._......-----•-------•--•--•••---•----....---.......--------••----•-•--•---••------••----•--•---•---....-•----....-----------•--------------- <br /> -------•----------- -----------------------------------------------------------------------------------------------•------------------------------------------------------------•-----•-----------•------------------ <br /> I heeceyt I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinancend regulati of the San Joaquin Local Health District. <br /> $i ned( 9 )-- .. --- --------- ----- --- -- --.... r and/or Contractor) <br /> -- -- -- - ---- <br /> BY: ----------- --------------(Title) <br /> (Plot plan, showing size of lot, location of system in relation to IIs, buildings, etc., can be place n reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ------- z`z ---------------------------------------- DATE----- � <br /> REVIEWED BY.............................------- .............. <br /> ---- •----- ........................................................... DATE........................................................... <br /> BUILDING PERMIT ISSUED..............................................................-...................................... DATEF-.IL <br /> Alterations and/or recommendations:----------•----------------------------------------------•---------•-----•--- --- --...------ � - <br /> ----------------------------------------------------------- ---- -- -- iii... <br /> -----.....--------------------------------------------..._..-•••-•---•-----•--•------------------------•---• ................................................................................................................ <br /> -------------•-----------•---------------------- ................ --•--•--------...------•--------------------••-••-•••----•------•---•-------•-------•---------- .......-•-•--•--•----•••----••--•-•--------------•--• <br /> -------------------•-------•-------- --- -- ------------....---- ............... ---•-- ------------------------------------------------------------------------------------------------------------------------------------ <br /> .... <br /> FINAL INSPECTION BY:..-��- - - ----�� --------- Dete_..._-�-�-/l �_---------`------------------------------------- - <br /> ---------------------------- <br /> SAN <br /> ­NLOCAL 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 8-59 2M 5-62 ATLAS <br />