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FOR OFFICE USE: <br /> ---- <br /> "---- �"""-- " --- --- --------- <br /> - --- ----------- APPLICATION FOR SANITATION PERMIT Permit No. ----- <br /> --- ------ __. . <br /> -------- - --------------------------------------- <br /> y -.-------_ (Complete in Duplicate) Date Issued ---_--- <br /> ----------- <br /> ------ /// <br /> -------_---------_-- - -.--_ This Permit Expires l Year Frbm Date Issue <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 applicati `n is made in compliance with County Ordinance No. 549. <br /> ]�j - 0-Q1� -H-- --------SCS ---- <br /> JOB ADDRESS AND LOCATION-.-_----" ----1-�- �Z --�� `�� = <br /> Gil D F_ F—scALOPI <br /> Owner's Name-- - `� - ---- ------------- ane------------------------------- g <br /> Address------ )Pi 1� 1 �. �- <br /> l. ..- "._- 1� --- Phone <br /> Contractor's Name-h-�------ -- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ] WORK10 ��V' <br /> - t. <br /> Number of linin units: - __- Number of bedrooms - <br /> .9 um f-baths ! -- Lot size -----_-� ___tA.G ---------PA.A!(` <br /> g :# .. <br /> Water Supply: Public system [_1 Community sy em ❑ Private Depth to Water Table! ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ElAdobe❑ Hardpan C]s <br /> Previous Application Made: (If yes,date------_---- l No Ef New Eonsfrucfion:-Yes EKNo ❑ - 'FHA/VA: Yes ❑ No Z' <br /> TYPE OF INSTALLATIOWAND SPECIFICATIONS: <br /> %. . , <br /> (No septic tank or cesspool permitted if publicseweris available within 200 feet.) <br /> r % , <br /> ,r 1X <br /> R <br /> � <br /> SeptiT nk: Distance from nearest wall_"` � m n- ------ ".Material- �------------ <br /> ___--_ ---- ----Nohof compartments -.-Liquid depth--�-------- ---------Capacity-J!5-00 <br /> f'{A'{�' <br /> Disposal Field: Distance from nearest well_�0-" ---"Distance from to to nearest lot iil_"- -_-_.... <br /> __----Len th of each line. 100 ---".Width of trench.----- <br /> Number of lines------ ------------- ------ <br /> TYP? of filter material-_ o; l�-.__Depth of-filter,material- l --------- <br /> Total length-----------f_ _ __---------------- r <br /> Seepage Pit: ' t Distance to nearest well_---------------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 <br /> ' ❑ ',. ` j Linirsg,material -__ = Diameter <br /> 7 . <br /> Size:;Diameter-----------------------Depth------------ -------------------- <br /> NSber of pits-------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-___---"--"_----"_.Lining material---.-""""".-----. _.---- _ <br /> ❑ Size: Diameter--------------------------------------Depth------ ----------1-------------=-------------------Liquid Capacity_--------------------------gals. U <br /> I r <br /> Privy: Distance from nearest we{I-__-._.-_----""---------------------------- --D'sstance from nearest building----------------------------------------- <br /> ' ' <br /> Dis ----------------- <br /> tance to nearest of ine------------------------- ------r---------------�----,--- --- <br /> ` <br /> - <br /> -Remodeling and/or repairing (describe):------ --"---- ---1-r------`--- --_----- <br /> ------ ----------------------------- <br /> ----------- --------------------- <br /> ------------ <br /> ---------"------ <br /> --------__"".- <br /> 1 . - <br /> ---------.----•----•-----•-------.--------------_----------.--- <br /> ---__------------_----------------- <br /> -----__ ------------- <br /> -------------------- <br /> ------------ <br /> _--__.- -__--.--// -------- ----.--•- , -----------------------------"------------------ <br /> •-------r------------ - ------ Y ----- <br /> ! hereby cer ify-fha- have prepared this application,arid that the work will; dance with San Joaquin County <br /> be done in accor <br /> ordinances, St-*.e. 16 ander and egulations-of ythe.,San Joaquin Local Health District. <br /> _ .' - - ` = {Owner and/or Contractor) - <br /> � -" Title---------------- ----------------------- ---- ----- -- <br /> 8 :_-- ------------ -- --- ---------- = { ) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc,scan be placed on reverse side). <br /> %, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- -' --------------- ------- --------------------------------------i; DATE------- j::- --�2 ---�� <br /> REVIEWED BY----- -----------------------------':------------------------- ------ -- <br /> ---------------- <br /> DATE------------------------------------------------------------ <br /> REVIEWED ------------ DATE---------------------------------------------- ------------- <br /> Alterations <br /> PERMIT ISSUED--------------------------------------''-'_"_":.-_------'--- -�--- ------------------ - <br /> Alterations and/or recommendations: ------ --•------------------•-------------------------------------------•-----•------------------- <br /> ----------------------------------"------------------------ -----•------------------------- <br /> ��."-.._. �,. s--- �-}•�------- - ---- 1 ------��s..._.- •_.:��. ----•- ---�< --- � ---- - <br /> ._ <br /> FINAL INSP Date`._:'_ i <br /> e <br /> U. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Aye. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 RE-VISED 9.59 3M 3-163 F.P.CD. <br />