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' FOR OFFICE USE: .M <br /> r - <br /> APPLICATION FOR SANITATION PERMIT Permit No. -17_31 '3 <br /> ..x.7.313 <br /> -' -------------------------- <br /> -------------- <br /> (Complete in Duplicate) , <br /> #- Thin Permit Expires 1 Year From Date Issued Date.Issued <br /> Application is- <br /> ,hereby made to the San Joaquin Local Health District for a permit to construct and in the work h ein described. <br /> This application is made 16"compliance with County Ordi ante No. 549. ! <br /> JOB ADDRESS A LOCATION tQ_ ---c�_--" _" _ ._." <br /> --------- ------ --- <br /> Owner's Name___ . ___{�y�---•--- hone- <br /> ` L� (/ -----•---•- - 7 f_-_�..'-�-�- <br /> ---------- <br /> --- - P <br /> Address-------- --_ <br /> --- <br /> Contractor's Name.----''-_.-•„" °"- -- _ <br /> e--- •-•--•�--- <br /> -- -----0-''----- <br /> ------- --- =. "t . on <br /> Installation will serve: lResidence [ Apartment House ❑ Commercial ❑ Trailer Court Q Motel 4 <br /> :Other ❑ <br /> Number of livin units. __ ._.__ Number of bedrooms f ` <br /> g ` Number of baths --------- Lot-size -".,l_ _._____.-•-""_-- <br /> Water Supply: Public9system� ❑ Community system ❑ Private Depth to Water Table _yQ ft. <br /> Character of soil to a depth of 43 feet: Sand ❑ Gravel E❑ Sandy-Loam` Clay Loam ❑ Ga Ad be Hardpan e <br /> 1 . t Y ❑ ❑ . ❑ <br /> Previous Application Made: {Jf yes,date__ . __..___ -----) No ❑ New Construction: Yes`❑ No'� FHA/VA: Yes ❑ No ❑ <br /> f � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200-feet.) { <br /> Septic Ta k: Distance from nearest well_L1 Q :Distance from foundation__ __ �__.._", .� <br /> _ Material / r <br /> ..�;.. <br /> No. of compartments___ _.___._:_..__.-'Size y a_ t _ Li uid�de th__.._ o d <br /> q p. -------------J Capacify.l - -- <br /> it <br /> Disposal Field. Distance from nearest well__�a-----Distance from foundation..1_0! -Distance to nearest lot line__..____`$"" <br /> Number of lines_.___" _ _"Length of:each Iin"e'* -SG-S- Width of trench____________ _f_____". <br /> •--- <br /> ' Type.of filter<,material____.!_ ._ --Depth.of filter material___ __.__...Total length--'-.,._ _____"_____. <br /> Seepage Pit: Distance to. nearest well---------------------- from foundation------------.T-__.".Distance to nearest lot line-------._._______ <br /> ❑ Number of pits---t- ------Lining material----------------------.Size: Diameter-----------------------Depth----------------•.._-- <br /> --------- N <br /> Cesspool: a Distance from,nearest well--------_____--_:Distance from found <br /> ation.--------------------Lining material-------------------------------------- <br /> ❑ Size: Diameter-- <br /> 474 <br /> -=-------------------- -------- Depth-------------- .:-------------•------=------- ---Liquid Capacity-------------- gals. <br /> Privy: A:. Distance from nearest well.---------------:_------------ ----- ----"Distance from nearest building-------.---------------- <br /> -__------__------- C <br /> ❑ Distance to nearest lot line-------,-'--------------"-- ----,;=--------------------------------- <br /> --------------------------------------------- <br /> --------------------------------------- <br /> Remodeling and/or repairing (describe):--- '----------- ---------------- <br /> -------------------------------- " <br /> 1 ; . ------- ------------------------------------------- <br /> ----- <br /> ---- ----------------------------------- .. <br /> ----------------------------------------------------------------------------"---------------=--------------••-------• = --------------- <br /> --------------------------------------------- <br /> ' <br /> ` I r f e <br /> - - --••----------------------------------------------------------------------�' <br /> -----------•---------------- ---•-------•--------=---=-----i-----------------•---------------------------.------------=------------- ---------------- ---------- ----- <br /> I hereb ertify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances Sta a laws, and rules and regulations of the San-Joaquin.Local Health District. <br /> (Signed) (Owner and/or Co ) <br /> ------------ -- --' -'-'---t-r------�--- <br /> b . <br /> OY:----------------•--- Contractor) <br /> _ . _ ._.___ wn � ctor <br /> -----------------------------------{rtle� � ' <br /> - ---------------------- ----- <br /> (Plot plan, showing size of lot, location of. system inre.tion to wells, buildings, etc., can be. placed on reverse.side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------- - --- ------ <br /> ------------------= ---- DATE._�"_�•-"�"�C <br /> -- -------------- <br /> REVIEWED BY DATE <br /> BUILDING PERMIT ISSUED-------------- `-------=------ ----- -------------------- DATE------------ <br /> ------------------------------------- <br /> Alterations and/or recommendations:___'..........------------------ ' <br /> -r <br /> ------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------- <br /> ._.__""___._"_""__"_"_-.____-..`--____"_--.----------------------------------- - <br /> p; - <br /> FINAL INSPECTION BY:_.__ -.-'-- -_ -- ------- Date-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1501 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Streer <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EV 9 REVISED 6-59 3M 3•'63 F.F.r-,G. <br />