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FOR OFFICE USE: <br /> -._._ ------- _________ _ ______ APPLICATION FOR SANITATION PERMIT Permit No. <br /> =-------- ------------- ---------------- ----- - (Complete,in Duplicate) v /0 /} <br />- -------------------------------------------------,---._-- This Permit Expi`res 1 Year From Date Issued <br /> Date Issued <br /> ' Application is hereby macle'�o the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in cpmplian�t C unty Ordinance No. 549. <br /> JOB ADDRESS AND L CATIO � ... 5 r <br /> Owner's Nam <br /> • - - - - - ------ Phone----- -----•-------- - --------- <br /> i Address-- ----- ,----- ----------------------------------------------•------------------ ... <br /> Contractor's Name------; ---------------1 -=---------•---------- ------------------------------------------ --- Phone................................... <br /> t Installation will-serve: ;Resiclencef partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> I Number of living units: __ ---_ Number of bedrooms S___ Number of baths_. Lot size _ <br /> I. Water Supply: Public€system ❑ Community system ❑ Private pth to'Water TableA tt <br /> F Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe g]-o Hardpan ❑ <br /> r Previous Application Made: (If,yes,­d'ate____..___..__._ _) No 0?`* New Construction: Yes ®/1`o ❑ FHA/VA: Yes Zj/- No ❑ f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) r t. <br /> Septic Tank: Distance from nearest well_ZA*'--Distance from foundation--?V__._.____Material ---------- <br /> No. of compartments.________________Size __'34X?Liquid depth__---�----_---------Capacityf���.________ <br /> Disposal eld: Distance from nearest well._ _.__.Distance from foundation_���__.____.Distance to nearest lo6t line_4`.------- <br /> Number <br /> ______ <br /> [ Numberof lines_______ _Len #h of each line __ _ Width of trench <br /> uType of filter mate i �� Depth of filter,material _,_�--------_Totail" length -_/4_2�--__ --------I-_--___ <br /> z,Seepage it: Distance to nearest well -_, .____Distance fr m fou dation . -, _.___.Dist a to riearest lot line_ ----------- <br /> P2 <br /> .- J <br /> i Nurnbar,of pits.'_;��____. . -Lining material___ r.Size: Diameter_ . __..__.. `Depths <br /> Cesspool: Distance from nearest well-----------------Distance from foundation __---------________Lining material------------------------.•_._______ <br /> " 0 Size. Diameter �;- ------- -------Depth---- --------------- --------- - --Liquid Capacity ----------------------gals. <br /> 71 <br /> /)!Privy: Distance from nearest well=•___'*_-------------------------------------- ---DistanceArom nearest building -----._••----------------------------_-- <br /> 1.c ❑ s' <br /> Distance to nearest lot line ______ __.____-___ . . <br /> �� — - <br /> % <br /> Remodelin9 and/or repairing <br /> : , = - <br /> - -- <br /> r <br /> r - k t, <br /> Wi------ r- <br /> _ <br /> ------------------------------------------------------------ <br /> k I hereby-•certify that I have prepared this application and.that +he.work will;be_done in accordance with San Joaquin County <br /> _ ordinances, State laws, a d rules and regula+ion o +he San Joaquin Local Health District. <br /> I <br /> (Signed)- f - -------------------- - -----------h?�or Contractor) <br /> �. <br /> B {Title) --------------- <br /> Y' <br /> ' (Plot plan, showing sixe.of lot, location of-system in rel n to'wells;buildings,-etc.,;can be placed'ori feverse-side). <br /> FOR DEPARTMENT USE O LY <br /> { APPLICATION ACCEPTED BY-------------=----------- ;• --- --- ---- DATE----- - ----------------- <br /> ��_ ` <br /> REVIEWEDBY--- ------------•------------------- -------------------------- {i--------- -------------- DATE----------- <br /> A BUILDWG PERMIT ISSUED-----------------------------------------1__.1 DATE- ` <br /> Alterations and/or recommendations:_-__/P.'_3,!�'_'b- -------__ ...... 4_ K---------- =-_"__-'_`:_:.--Ys-'-----------------------I ---- <br /> --- ------- ----------------- �_='== ----------- -----_------------- <br /> sF ip <br /> ___________________-._-.-.__._____ -------------------------------------- --------------------------------------------------------- <br /> ------ <br /> ____-__- <br /> - ......... .___ _____________________ _ <br /> • .n.�. ?rte... � _ _ --, .- . <br /> FINAL INSPECTION BY---------------------- F I -- -- Date---------- `--------- --------------- <br /> 3 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California ` Lodi,California E Manteca;..Coliffoornia 1 s �� Tracy,California <br /> Es 9 REVISED 13-59 3M 3-'63 r.F.q D. � <br />