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FOR OFFICE USE: � �. <br /> -` r)le <br />-------------------------------------------------------- <br /> APPL.ICATION'�R SANITATION PERMIT Permit No. AJOx- <br />--------- -­---------------------==------ -- ------------------------- (Complete in Duplicate) - <br />-----------------------------------------_-___._._._._-_ This Permit Expires 1 Year From Date Issued <br /> Date Issued -------------l� <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. ( 8 i25-0- 2-If <br /> JOB ADDRESS ANDOCATION:- t ..._.. l��t._ '° ''- -- �� <br /> Owner's Name ` -•---------------------------------------------------------- ------- Phone---------_-...................... <br /> Address...... --• ...... ------ <br /> Contractor's Name------- ----- •------------------------------------•-------------------------------•-••----------------•----•------------------ Phone---------------•--- <br /> Installation will serve: Reside e ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> C � <br /> Number of living units: ________ Number of bedrooms -------- Number of baths -------- Lot size ,_3_,'.Water Supply: Public system ❑ Community system ❑ Private [, Depth To Water 7ab6 t. j <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No 14 New Construction: YeSANo ❑ 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.) <br /> Septic Tank: Distance from nearest well _Dista ce from foundatin___�p________-Materil______------------- <br /> Liquid depth-. -- --- l-----�- Ca acity- `•+-• � <br /> ..No. of compartments_________ .. _Siz A J�_x-t <br /> Disposal Field: Distance from near t wellj_P_ Distance from foundation-----br.___.Distance to, earest lot <br /> ry Number of lines--- ---------- ------------ --Length' of each'line-j-49-7/4WWf/ idKi/ nch._...__sC�_ ----------- <br /> Type of filter material, _Depth of filter material_____ __ __________Total length-----a___ti? .•__-__-_----______.._. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation__....--------------Distance to nearest lot line................. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--- ---_ Dept h---------------•----------------- <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 /> Remodeling and/or repairing (describe):--------- ---------------------•------ ---------------•-•------------••------------------------- -----------.......-------•--------------......-------- <br /> -------------••-•--•--•------•-•------------•-------------- --•-------------------------- -•--•----------•---•--------------------------------------------. --------•-------_._--.--------.-_-•------------------------------ „ <br /> --•- • ---•------------------------•-----------------------------------•---------------....-- ---- <br /> , <br /> ---------------- •-----------------I------ ---------------•------..-..__._._.-------------------------------.--•------------••------------••------------------------- --------------••--•---------------•- <br /> 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 /> _ - - . • / <br /> (Signed)-f--y�� -�._��^'�-r�.�r_"..'�.'ic„,•---- - ,__:.-- - �2.,Q'.-�-- - ---t�- --------- ---------------------(Owner and/or Contractor] <br /> ------------------------------------•-------------------- ----------•�----------- ------------------------ (Title)----- <br /> - -------- -- ----- <br /> By: <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE--------_----.-_--------------•------------------------ <br /> REVIEWED BY---------------------------------------------------------- DATE-----/.--n ------ <br />+ BUILDING PERMIT ISSUED--------------••--------- DATE---------------- _ — <br /> Alterationsand/or recommendrations:----------------------------------------------- --------•--------------•-------------•-------•-----••----••-----------•--------•-._...-•--•----------------•--- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------- -••--------------•--••-------------...----------------=-----------------•--------------------------••-------------------------•----•------------------------------------------------•-•------------------- <br /> --•---------------------------------- ----------- --•------•-----•-------------------------------------------------•-•-----------------------------•--------------•••--•----••----•--------------------------------------- <br /> ------------ --------•-------------------------------- ------ -------------•-------•--------•-----------••----- -------------------•-------•-- .- --------------- <br /> FINAL INSPECTION BY------- ---------- ----- --------------- -----• Date--------3-------t •-!777:(" -------•---------------------------- <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 r an <br /> i teca,California Tracy,California <br /> ES 9 REVISED 9.59 ZM 5-52 ATLAS <br />