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OFFICE SE <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> - ------------------------------------------------------- (Complete in Duplicate) Date Issued <br /> ----------------------------------- a-....-----.. This Permit Expires 1 Year'From Date Issued <br /> Applicition 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 maZle in compliance with County Ordinance No. 549. <br /> IT, <br /> JOB ADDRESS AND.LOCA .10 -----------/---- ------- _441----------------------------------------- ------------------------------------- <br /> ,N <br /> � <br /> �e 4? <br /> Owner's.,Na 0.. -. ...................._....... ................ ----------'­­----------------------------- mm-.-,--------- Phone..._..........------------_------- <br /> Address------------------ <br /> ---------- ----------------- --------------------------------------------------------------------------- <br /> Contractor's Name------------------------------j -------:_w. ----------_--------------------------I-------------------------------- Phone................................... <br /> / e_t <br /> Installation will serve: Resiclence�Aparfmenf House [] Commercial E] Trailer Court C] Motel10 Other 0 <br /> Number of living units: ___1-- Number of bedrooms Z= Number of baths J_.... Lot size --- ............................-_------- <br /> Water Supply: Public system El Community system E] Private E] Depth to Water Table ft- <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [] Sandy Loam El Clay Loam 0 Clay 0 Adobe.{5Hardpan C] <br /> Previous Application Made. (If yes,date---------------------) No ED/'**New Construction': Yes Eg� 0 PHA/VA: Yes El No E---" <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.} <br /> Septic Tank: Distance from nearest well__�---—---------Distance from foundation--- __n.i Materiai-_/__ a'. <br /> -�' <br /> No. of compartments------,?-—----------.--Size___,5Xr_M_V_Q--------Liquid cle ---------I .-Capacit --------- <br /> Disposal Field- Distancenearest well____ from foundafion,__)a-----------Distance to nearest lot_r_ine�-------------- <br /> from ne 00, <br /> Number of lines--------------I-------------------Length of each line-------9A*---- ------Width of trench.-P-Y------------------------ <br /> Type of filter material__)_�1y__A_0C_e---Depth of filter materiaf_,/'_?�! -----Total length--- _�70-------------------------- <br /> Seepage,,Pi[t: Distance to nearest well- —Distanc -from-f n n--/...............Distance to nearest lot <br /> Number of pits-------i------------Lining mater 'Ze: Diameter-- -------- 'Dept h----- -- X.. ...... <br /> Cesspool: Distance from nearest well------------------Distance from foundaficn___`-----------------Lining material___-____-__-____________.__________-_ e <br /> ❑ <br /> aterial------------------------------------- <br /> E1 Size: Diameter:.;-----------------------------------Depth--- --------:---------------------Liquid Capacity------ ------------_._g ols. <br /> ------- <br /> -Dista'ri-ife' r5ffi-4n&a_­r_ <br /> Privy. f esf well----_------- ---------------------------Distance from nearest building__________-_____________________--____-. <br /> 0 Distance to nearest lot line--------------------------------- ------------ ----------------------------------------------------------------------------------------------- -1� <br /> Remodeling and/or repairing (describe);------ <br /> - -- <br /> ---- ---- -- -----------------•----------------2 ---- ------------------=-=------ <br /> - ------------ <br /> ------------------------------------------------------------------:• •----- -------------•--------------•--••------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------­.............-------------------------------------------­­­------------------------- <br /> ----------------------------------------------------I--------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that _have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law�ps,,/Sqnd�yles and reg <br /> A <br /> la ions <br /> of the Sao oaquin Local Health District. <br /> Signed ----------- --------( <br /> ­-- ---------(Owner and/or Co-n--t-r--a---c-t- <br /> or) <br /> By:------- ------- ------- ---- m --- (rile . <br /> (Plot plan, showing size jot, <br /> location of system in relation to Wells, buildi)igc�efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ---- ------ DATE-- <br /> -------•---- - -�j--------------------- <br /> --------- ---------------------------------------------- <br /> REVIEWEDBY------------------------------------------------------------------------:------------------ . ........DATE--------- - -------- ----- -- --------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------- ----------- - ------- -- - ------------- DATE-------•----------------------- ------------------ .......... <br /> Alterations and/or recommendations------- ------- ---------- ---------- --- ----------------------f------------------------------------------- ------------------------------------------------ <br /> ---------------------------------------------------------------------- ......................­­--------------------------------------------- <br /> --------------------------- ------------------P----------------------- <br /> Zr+ --------------- -- -------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- <br /> ------------- -- ------- ------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- <br /> FINAL INSPECTION B --- ---------- Date-------- ----- <br /> SAN JOA9U IN 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 /> CO-9 RC%OIZCD 0-59 F.P.CD,ZM 6-60 <br />