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-- ----�— <br /> .. <br /> ---------------- <br /> -------------- <br /> --------------------------------------------------------- ...APPLICATION FOR SANITATION !_xM1T Permit No. _.f. <br /> ---------------------------------------------••---------- (Complete in Duplicate) '? <br /> �6 <br /> ------------ --------------- ------ ,This Permit Expires 1 Year From Date Issued � Date Issued ._._.��/z-1-.:1. <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__ <br /> Owner's Name.- ......... Phone--- <br /> ...................-1----------------------------------- <br /> hone------------------------•----------------------------------- - <br /> Contractor's Name -. = -•------��e's :T�Ser icy---------•----------------------------------•-•...... Phone................................... <br /> Installation will serve: Residence ❑ Apartment-House ❑ Commercial (:1 Trailer Court ❑ Motel ❑ Other )a <br /> Number of living units: ________ Number of bedrooms _______• Number of baths -------- Lot size ........................... <br /> Water Supply: Public system ❑ Community system'❑ Private 51 Depth to Water Table _______, ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel D.t Sandy Loam 10 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date______--______.____) No ❑`S`iNew Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ; <br /> lNo septic tank or cesspool permitted if public sewer iso available within 200 feet.) <br /> I ' 1 <br /> Septic Tank: Distance from nearest well�Q----i-_Distance from fourgdation----to---______.Material -.LtIJd.I_.C_e.................. <br /> No. of compartm rets------------o'a----------Sze__.__a kl_0--f._1d.Liquid depth.......sr-----...........Capacity.4t 4 <br /> Disposal Field: Distance from nearest wellQ.__ on__Distato <br /> from foundatio..._�_-Distance to nearest lot line................ <br /> Number of lines_..---------------- ! _.Len th of each line______- --#•____,Width-ofptrenc_.h...... --- �,••_ <br /> Type of filter materlal.J1kZp_0_- -_____Depth of..filter material__L- --------------Total length.___ --------------- <br /> Seepage Num <br /> a-Pit: Distance <br /> of pits to rest well- -.-_-_Distance fromfoundation ...............Dista Distance to nes est lot line----------------- <br /> - --Liningsmaterial.. ---- >„ ----Size: Diameter-----...................Depth---------.---------.---_------ <br /> Cesspool: Distance from nearest well________________•Distance om foundation'_________-- ___.Lining material-.-_____----._.________...._......... <br /> y }s ept ---------t..:-------•---- `= ----------Liquid Capacity---------------------------- <br /> Priv Distance from r nearest well-__ -.'.------_------_-------------- _----_Distance�fromnearest building--------- -------------------------------- <br /> Distance <br /> ________________ ___ <br /> 1 It <br /> Distance to nearest lot line --- ------------•----------•---•----•--------•------------.-__-...------------------•--•--------•--------------...--------------- <br /> Remodeling and/or repairing (describ� :------------�.�__��h '---------- ----------------------------------- <br /> ............---•.......... -------------------------------- i------'----• -------------------------------------------------------------------............................------------- <br /> --------------­-- --------------------------------------------I I <br /> -------•------- <br /> --•-----------------------•---------------------------._ .....__X� ,._...,.. ..f j � <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, State laws, and rules and regulations of the'San Joaquin Local Health District. <br /> (Signed)----•-••---------------- <br /> --------- ------------------(Owner and/or Contractor) <br /> $Y= `----------------------•----------------------(Title}---------------------------------------- - --------------------- <br /> (Piot plan. s ow 1ze of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> ---------------- DATE _ ."_ ._2-... <br /> REVIEWEDBY gr,00-------------------------------------------------------------------_---. DATE------------_--- <br /> - --------- ---------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE <br /> Atterations and/or recommendations:-------------------------------------- <br /> ----------------------- <br /> ..--•----•------------------------------ATI' -..--Thas.__scas.._appruved__by---phone_-by__j_D_L___because..of..Qvr_-inahilf ty--.-to---------- <br /> ----------.----------------------------------------------inspent-.on---time-._____He---rece-imed__O_S_from..awned.Ahat__ayatem._had_.beem.._.... <br /> ...............------------------------------------------insta L1ed__s.atis£acto-rity------------------------••---------------- <br /> -------.--- - -------------- ----------------------------------••- ----- <br /> F1NAL INSPECTION 8Y: - ------ Date _ / -iE,- -`=:: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 6.59 2M 5-61 ATLAS <br />