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47 <br />�{{ yt APPLICATION FOR SANITATION PERMIT Permit No. <br /> } U (Complete in Duplicate) 0 / <br /> Date Issued ___/ <br /> Application 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 made in compliance with County Ordin nce No. 549. jJ <br /> JOB ADDRESS AND ATfON_____ /U_a,— � <br /> -- ---------• -----------------------•------------------------- -----------•--------------------------------- <br /> Owner's Name__ { ---- Phone-- <br /> Address- � yc. � I <br /> -•---------•---------------------•---------•---------------------------- -- -------- - <br /> Contractor's Norrie -•-1. Phone - <br /> ------------------------------------------------------ <br /> Installation will serve: Residence ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number ofg units::--/-- <br /> :livinNumber of bedrooms __ __ I f <br /> R � � a2__ Number of baths 1__�Lot� size ------ <br /> Wafer Supply: Public'system,RR'<ommunity system ❑ Private ❑ Depth to Water Table -yw)ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam ❑ Clay ❑ Adobe �ardpan ❑ <br /> I , a <br /> Previous�Application Made: Yes ❑ No © New Construction: Yes ❑ No Eq�HA/VA: Yes ❑ No ❑ <br /> K <br /> TYPE OF INSTALLATION AND SPEC]FICATIONSs <br /> f(No septic`tank or`cesspool permitted if public sewer is available within 200 feet.) <br /> k: Distance from nearest well_______________Distance from foundation__._________.__.--_.MaterialNo. of compartments---------------------•----Size-----•----------------------:---Liquid depth--------------- ----------Capacity- <br /> q�fh <br /> I vi Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-------.._____--- <br /> :. Number of lines-----------------------------------Length of each line------------------------------Width of french <br /> 1 Type of filter material-------------------------Depth of filter material-----------------------Total length-----------------_------------_--___------ �) <br /> i !� <br /> Seepage Pit: Distance to nearest well_ - _ /� <br /> Distan om f undation____ ff------Distance to nearest lot line_- _____... <br /> n' . .Number of-pits--.___--/-----------Lining material _ ----Size: Diameter----- <br /> Cesspool: Distance from nearest well_________.___._-Distance from foundation--------------_----_Lining material____-_________ <br /> ---------------------- <br /> Size.tDiameter----------�---�---�----------Depth----------------------------------------------------Liquid Capacity------------------ gals. <br /> Privy: Distance from nearest well_____-.___I------------------------------------__Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line--------- ------------------------------------------------------------- -- <br /> - ----------------------------------------------------------------- <br /> 00 <br /> Remodeling and/or repairing (describe):-------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------------------- <br /> -------------------------------------------------------------•---------------•---------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby tify that I have pr ared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, a e laws, and rul an regulations of the San Joaquin Local Health District. <br /> (Signed)____ ___ Owner and/or Contracfor) <br /> --------- -- ---I <br /> •-------- ----- ------(Title).---- <br /> - ------------------------ -- <br /> plan, showing size of lot, loco ion of system in relatio }o wells, buildings, etc., can be placed on reverse side). <br /> .FOR.DEPARTMENT USE ONLY <br /> APPLICATION 'ACCEPTED BY------------------- <br /> ----------- DATE <br /> -- <br /> ---------- -- <br /> REVIEWED BY---===--------------- -"." -== r..-1 <br /> -------- -- <br /> ---- -- ----- ------------------------------------ <br /> --------------------- DATE----- <br /> ------ <br /> ATE / 5 <br /> ----- - ---------------- <br /> BUILDING PERMIT ISSUED---------=-----•---------------- . "--------------- ------ DATE'--- <br /> ---------------------- ------------------------------ <br /> A aerations and/or recommendations:_______.._._-_____________- - <br /> .. <br /> ----------------------------------•----------------------- <br /> -------------------- <br /> ----------------------------------------------------------- --------------------­­---------- <br /> -----------`------------------------------ <br /> r <br /> -------------------------------------------------------------------------------------- <br /> - --------------------------------------------------------------------------- <br /> --------------------------------------------- <br /> FINAL INSPECTION BY:---- .!L---�_-- rAQQUIN <br /> ----------•- -- <br /> SAN J LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street .. 132 Sycamore Street 814 North "C" Street <br /> Stock+on, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M , Revisea 1-57 EP.CO. ' <br />