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FOR OFFICE USE: <br /> ------------ <br /> ------ .FOR SANITATION PERMIT Pefmit No. ......��.__�_ <br /> --------------------------------------------- 4...__... (Complete in Duplicate) ®� <br /> ; Date Issued ........ <br /> ---------------------------------------------------" - This Permit Expires I Year From Date Issued <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 /> CATION ;JOB ADDRESS A <br /> Owner's Name....... - / ----- ---------------------------------------------------------------------------• =- Phone----_---------------------------- <br /> i �.-- - - '✓-------------------------= ----= - ------ , <br /> Address • .----• .------- <br /> Contractor's Name--------------------•.- � �' --_-._-- Phone.----.•.----•-.-.-•-....._ <br /> Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ <br /> i <br /> Number of living units: _/___ Number of bedrooms ._o Number of baths __ __ Lot size _____________________ <br /> E Water Supply: Public system 0--tommunity system C] Private [j' Depth to Water Table .y- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2-11ardpan ❑ <br /> Previous Application Made: (if yes,date____________________) No ❑ New Construction: Yes ❑ No ❑---F_HA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _y <br /> r _...a. -�- <br /> p c tank: Distance from nearest well_________________Distance from foundation--------------------Material______________.-_................................ <br /> No. of compartments--------------------------Size--------------------------------Liquid depth__.:------------------------capacity....................... <br /> is I , ield: Distance from nearest well-________________Distance from foundation....................Distance to nearest lot line.______.-___---._ <br /> _..... ._ .. ­ <br /> Number of lines. -------------------------------Length of each line-----------------------------.Width of trench----------------------------------- <br /> F Type of filter <br /> material._---_._______--------- <br /> Depth of filter material--------------------._-Total length.----------------------------------------- <br /> Seepage Pit: Distance to nearest well ____ -_Dista om oundation_.r! ..........D'stance�to nearest lot line_ __ .. Q <br /> Number,of pits-----/-.--:..0___Lining mate ial__ �_C_ .__ __._Size: Diameter.......t,. Z..____.Depth.....2� ............... �I <br /> Cesspool: Distance from nearest well-----------------Dist ce from undation--------------------Lining material..................................... V <br /> ElSize: 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}:__'1AG ____.!l-���� ------- - `..._. , <br /> 1 t <br /> - -- ----------•--•------•------•-••-----------------°--------------------------------------------------------------------------------------------- --------------- --------- ---.....--......•--.-- <br /> --- -- --•-------------------- -•---.....--------------...-....--•-----••--•----••-----------------------•-------------------•--------•--------------.-....-......----------------••-------- <br /> I hereby ce ' y that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St a ws, and ules andr guI tions of the San Joaquin Local Health District. <br /> [ <br /> {Signed].------- - :-tl------ ---------V--- ----- -----------------------•}----------------•--•---- wner and/or Contractor) <br /> Sy:._.. I - ---- -- - ----------------------------------(Title)---- ------------------------------------•---- <br /> (Plot plan, showing size of lot, location pof system to relation wells, buildings, etc., can be placed on reverse side). <br /> ' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY(_ t ^— -"t -------------------•---- DATE <br /> REVIEWEDBY------------------- ----- ---"-----::-=---<--------------------------- ----------------------------------=-------•-•- DATE-----------•----------------------••---- <br /> 1 BUILDING PERMIT ISSUED_J ---------- DATE---------- --- - <br /> Alferations and/or recommendations:--/ -- -------- `"-li ._, ��.�_ e _c� � L -------------------------------------------- <br /> t ---•••--•-------------------------------------------•----•-• ............ - .._.. <br /> r . _ �.4 - - . �- - . <br /> -----•----•------------------------------•---•--------•-------------=.---- ---•----------------------------------------------------------------------------------------- <br /> ------------•-------------------- --------------------- -----—----------------------------------------•------------------------------------------------------------ - -•----------------•--•------------.._.._-- <br /> t <br /> FINAL INSPECTION B :.. .___ .. . _ 1/!1_k . . Date........... _ <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 Mantua,California Tracy,California <br /> ES 4 REVISED a-59 EM 5-61 ATLAS <br />