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FSM <br />'APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />" / . I _. 1; . <br />t�f ApplicAZon.is- hereby mado ' " <br />to the San Joaqui <br />This appli6tiori is made in compliance wit <br />JOB ADDRESS AND ATI <br />0imer's Name----- <br />I <br />I <br />- r_2 <br />2 Add -- ------Aa �----------------- ...... <br />Permit No. <br />Date Issued --- <br />Local Health District f6r a permit to construct and install the work herein described. <br />my Ordinance* 49, <br />--- ------ ---- -------------------------- -e - -------- 'j'. <br />-------------------- - -------------------------------------------- P <br />/On <br />&------------------------------------ <br />------------------------------------------------ <br />Contractor's Name ------- 7-o ---- - ------ ------- -------- g4 ---- Phone <br />Installation will serve; Residence [] Apartment House Ej Commercial Trailer' Court '0 Motel 0 Other <br />Number of living. units:__.._ Number of bedrooms -------- Number of baths -------- Lot size <br />Water Supply: Public system IV Communify system rE] '*Private ff"De pth to Water Table -------- ft. <br />Character of soil to a depfWof 3 feet: Sand Gravel [] Sandy' r L ClayLoamo ClayE] Adobe [:] HardpanE] <br />Previous Application Made: 'Y'bs 0 No ;�ONew Construction: Yeso;No E] FHA/VA: Yes ❑ No <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or' cesspool permitted if pybr,5(sewer is available within 200 feet.) <br />�ejp f d a <br />Septic Tank: (7i Di;tan f est weII_X,_4X4Di,ta,' <br />'m n' ----------- k ---------------- <br />;� from <br />s ---------- —2 --- ------ _-Liquid ---------- Capacity --- <br />Disposa� Field':7, Distance from nearest -well- !2_�_Disfance from foundafion__/A ___t__Disfance to nearest lot <br />Number -of lines___. - Length of each line ----- 45-47 Width of -french___ -s2 <br />A -------------------- <br />Type of filter maf.0 --- of filter material----- <br />Af ------------ Total le"n'gth --------- ------ ---------------------- <br />Seepage Pit: Distance to nearest well -------------- --- <br />------ Distance from foundation______--- ------------- Distance to nearest lot :line______.__________ <br />❑ Number of pits---------------------- Lining material -----------------------Size: Diameter_---------------------- Depth--------- - I ------------------------ <br />Cesspool: Distance from nearest well ----------------- DistanEe from fou1ndation -------------------- Lining material_______________-.___.________________- I -- <br />E] Size: Diameter-------------------------------------Depth------------------------------- --------------------Liquid Capacity ------------------ r ---------gals. <br />Privy: Distance from nearest well___-________._.___:__,__. --------- --- .________Distance from nearest building._____.________________________._____.._f <br />F1 Distance to nearest lot lin <br />- --- ----------- ---------------------------------------------------------------------------------------------- <br />---------------------------- <br />Remodeling and /or repairing (describe): <br />------------------------------------------------------------------------- -------- <br />----- <br />--------------------------------------------------------------------- : ---------- -------------- ---------- i ----------- ---- <br />------------------------------------------------------------------------------- - -----------------------•--; ------------------------------------------------------------------ Z ------------------------------------------------ <br />--------------------------------------------------------------------------- ---------------- I --------------- ------------------------------------------ -- I --­------------------ ----------------------- <br />---------------- ----- <br />I hereby certify that I have prepared this application 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)-- ------ ------ ------------------------------------------------------------------------------ (Owner and/or Contractor) <br />BY=-------------------------------------------------------------a ------------- ------------------------------------------------------ (Title) ---------------------------------------------------------------- <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,, can be placed on reverse side). <br />FOR ?EPAkTMENT USE ONLY <br />APPLICATION ACCEPTED BY________________ ----------- I -------------------------------------- DATE ------ <br />--- <br />BY----------------------------------- ---- - 47 <br />- ------ 7 -------------------------------------------------- DATE-------- <br />- <br />BUILDING PERMIT ISSUED------------------- -- - - - -------------- <br />Alterations and/or recommendations - ----- ----------------------- DATE ------------- <br />-------- - ------------- -- --- <br />---------------------- ----------- --------------- <br />----------------------------------- -------------------------------------------- ? _-21-5 ------ ------------------------------------------------------- <br />---------- ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------ <br />--------------------------------------- ­­ ------------------------------------------ ---------------- <br />-1 -------------------------------- I - <br />------------------------------------- <br />FINALINSPECTION BY: ------------------------------------------- -------------------- Date-: --------------------- -------------------------- <br />------------------------------ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street <br />Stockton, California <br />ES -4-2M - Revised 1.57 FRCO. <br />300 West Oak Street 1 132 Sycamore Street 814 North "C" Street <br />Lodi, California Manteca, California Tracy, California <br />