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-._._-.--__.__. ---------------------- ---------- APPLICATIO13 FOR SANITATION PERMIT Permit No. <br /> --------------•----------------------------------------- (Complete in Duplicate) <br /> --------------------------------------- <br /> --- ------ This Permit Expires I Year From Date Issued Date Issued <br /> o F 3 33 0--&., <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and-insta the work rein described. <br /> This a plication is made in complia a with Count Ordinance No. 54 . <br /> Z4 ,sJ- K�'w i Yti - � <br /> JOB ADDRESS AND OCATIO � r s'; e"� """o ' �t.?` .:._.. u � f <br /> Owner's Name__ _ .�- <br /> - ---- --------•----•--•---- ---- -•-•------•• ----------•-----•-----------------•- ----------.____.p _.__. Phone__ <br /> y� n -._._ /� �'' ,� �--• --------f--�--� --- <br /> Address `' 'aXl" +=" r ```� ��_A�-•----- <br /> Contractor's Name... �l� ... - - --•11 • -... C -w............................... Phone.. .......C.. TI <br /> Installation will serve: Residence ®-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ _ Number of bedrooms ._Number of baths Z_ Lot size .._.._._ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tablet. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San oam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: (If yes,dote____________________) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ -� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> is T Distance from nearest well_________________Distance from foundation--------------------Material................................................. <br /> No. of compartments--------------------------Size.----•--------------------------Liquid depth---------------- ---------Capacity....................... + <br /> � t <br /> sp al �: Distance from nearest well_/.f_49_9_r._Distance from foundation----A� =Distance to nearest lot <br /> Number of lines_____ ---------------- -----Length of each line------- ___�-r...._.__ Width of trench_ <br /> Type of filter material._ i Depth of filter material,------,1Y- ----Total length-,,,...­----------------- <br /> Se e Pit: Distance to nearest welLf�T'LZ----------Distance from f undation__.._4.49......Distance to nearest lot line...... _4 <br /> ed►� Number of pits-------I------------Lining material___ r_.-.Size: Diameter_...._ Depth----- r....... <br /> .---- <br /> Cesspool: Distance from nearest well-----------------Distance from ound6tion___.______-____-.-.Lining material----------------------------..___---_ <br /> ❑ Size: Diamefer-_-•----------------------------------Depth-----------------------------------------------...._Liquid Capacity-----_----•-------------.-gals. <br /> i <br /> Privy: Distance from nearest well__________________________________________ _____Distance from nearest building---------------- <br /> ------------------------ <br /> Cl Distance to nearest lot line. --------------------- --••---.....--------------------------�_ <br /> Remodeling and/or repairing (describer , <br /> ------------ ---------------- <br /> ------------- <br /> OF <br /> --- . - - ---- ----• •--•--------•------•------•-•----------------------- <br /> •---------------------------=------------------------•----------.......----------••---------------------------- --- ---- <br /> I hereby certify that I have prepared this application and that t e work will be done in accordance with San Joaquin Coun <br /> ordinanc�StatS, an rules and regulations of the S Joa uinL ealth District. <br /> (Signed)- ---------- �1� 1 <br /> Contractor) <br /> By:_---------------------------- ---------------- ------------------------------------- -- - - - --- -------- ------(Title)__..---------------------------------------- --- -------------- <br /> (Plot plan, showing size of lot, location of system in relation to uildings, a ., can be placed on reverse side). <br /> FOR DEPAktMENT USE ONLY f <br /> APPLICATION ACCEPTED BY------ '= . ••----- - - -----------•---------- -•------••------------- DATE---L�...T - <br /> - -- <br /> REVIEWED BY__....._.. -------- DATE_-. n <br /> BUILDING PERMIT ISSUED-------_- --------------------------------------------------------------------------- DATE <br /> !l Alterations and/or r9comrpendations:. --- ........ --------- <br /> --- --- <br /> ��..... .. ... . ----- ------------ - <br /> ---------------------......................................................... --------------------•-----­- --------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:......�J — Date.----- ------- 2 (C <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 Manteca,California Tracy,California <br /> E6 9 REVISED 8-59 $M 8-51 ATLAS <br /> E' <br />