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APPLICATION FOR SANITATIOWPERMIT Permit No. ./Y. <br /> (Complete in Duplicate) <br /> Date Issued ------ <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and instal[the work herein described. <br /> This annlication ' made in compliance with Counfy Ordinance No. 549. <br /> JdBZD&EXAND LOCATION_ A <br /> ---- -------------- --- <br /> -7 - <br /> Owners .... <br /> Name-- ................ ----- ------ - --------------- ------------------- -- -- Phone---------- <br /> Address--- <br /> hone------------------------------------ <br /> I described. <br /> ------------- ....... <br /> Address---- <br /> ❑ <br /> ----­----------- -----------------------------•----------------------------11--------- <br /> Contractor's Name--------- I----------- ------------------------------------------------------------------ ------------------------------------------- Phone---------------- -------------- <br /> Installation will serve: Residence Apartment House F7 Commercial E] Trailer Court E] Motel <br /> k'6"2 <br /> Number of living units: -----.__ Number of bedrooms -------- Number of baths -------- Lot size <br /> ------------------------ <br /> Water Supply: Public system E] Community system El Private 0( Depth to Water Table -------- ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay El Adobe [I Hardpan El <br /> Previous Application Made: Yes E] No V New Construction: YesA No Ej FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Li <br /> Se ' Tank: Distance from nearest we�lj&_49_41)isfance from foundation----Ik-------M Irial----1_244,4. <br /> 45 _' a <br /> No. of compartments---47)-----------------Sizo_5"X0---X,_(_2___Liq,id clep�h <br /> Y—�-------Capacityl-7 <br /> Disposal'Relcl:' Distance from nearest wellAA_:+ -Distance from founclafion____'_?_'_'__(_0_---------Distance to nearest lot I' <br /> 0 '�------------- <br /> fh f filter material_--- length-----/70------------------------11 <br /> Number of Length of each <br /> x - .2 A&icifh of trench-------------- -- ------------ <br /> Type of filter Dep o <br /> Seepage Pit: Distance to nearest well_---------- ------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits---------------------Lining material-----------------------Size: Diameter----•------------- ----Depth--------------------------------- <br /> Cesspool: <br /> ept h--------------------------------- <br /> Cesspool: Distance from nearest weJI-----------------Distance from foundation---__------_ -----.Lining material---------------------------------------- <br /> ❑ <br /> Size: Diameter--------------------------------------De- - pt h-___�-------------------------------------------------Liquid Capacity------------------K----------gals.� � <br /> Privy- Distance from nearest well-------------------------------------------------Distance from nearest building_-------______--__----__----------_-__.-. <br /> ❑ Distance <br /> uilding---------------------------------------- <br /> Distance to nearest lot line <br /> Re odalin) and/or repairing (describej-.o$6e.'.,cgo-- -------- ----- -- -------- of <br /> ----------------- <br /> --- - ----------- ------- ------A--------- <br /> ------------------------ ------------------ ---- ----------- ------------- <br /> - ------------ -------- ... <br /> -- -------------------- ---- -------------- <br /> W.0- ------- If------ -------------------------------------------------------------------------------------------- <br /> h r y certify that I have prepared this <br /> sillapplication 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)- r4o -- ---2 0 ;.--- <br /> -- -------- ---- -- ---------------------------------------------------------------------------------------------- (Owner and/or Contractor) <br /> 13 ... _r <br /> - ----- --------- ---------------------------------------------)Title)-----fl-); _"--�_ --­------------------------- -- <br /> (Plot plan, showing Sze of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------------------------------ --------- ---------------------------- DATE---- <br /> REVIEWED BY------------------------------------------------------------- DATE---- <br /> BUILDING PERMIT ISSUED----------------------------- -----------------DATE <br /> Alterations and/or recommendations:-------------------------------------- v <br /> ell ----& <br /> ---------------------------------------------- ----------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------I------------------------11---------------------------------------------------------------------- ------------------------------------------------------------------------------------------ <br /> ------------I----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------- ------ -- -- ------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:. Date........... <br /> 5r.-.4-------- -- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore SfrW 814 North "C" Street <br /> Stockfon, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 1-57 F.P.Co_ <br />