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APPLICATION FOR SANITATION PERMIT Permit No. .-/..-. .. �- <br /> •� (Complete in Duplicate) <br /> Date Issued <br /> Application is hereby madeao-.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 Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.....23 --------�-.-------EW;�1-�-_ <br /> Owner's Name-------------Kr&tj-�-��-}---------�-------..�5m-1T----------------------------------------------------- Phone-----•-----------------------•- <br /> Address--------------------------2a0---B- iZ 1E.IJC 1-A 0. <br /> Contractor's Name---------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] <br /> Number of living units. -1.----- Number of bedrooms I-- Number of baths J---- Lot size -----_------------------------------------------------_-.- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sa E] Gravel E] Sandy Loa E] Clay Loam E] Clay E] Ado6e� Hardpan E]Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T k: Distance from nearest we111*N1-,DistaF <br /> from foundation---I-&---------Matperial_REDW-'0Q <br /> No. of compartments- ----- ---------Size-- ------------------------Liquid depth---y------------.-------Capacity--•- - <br /> Disposal Field: Distance from nearest well...... Distance from foundation--------------------Distance to nearest lot line----------------- <br /> -F)W�"I'iNGr— Number of lines-----------------------------------Length of each line------------------------------Width of trench----------.-------------------•---- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length-__---......--_------._-----------.----.- <br /> a <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation----.---------------Distance to nearest lot line------------------ <br /> F-1 <br /> _-------.-- --❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------.--------------Depth----------------------------:--- Q <br /> Cesspool: Distance from nearest well-----------------Distance from fou_ndation-------------------.Lining material-.._._-------.----...._._,---------. U <br /> ❑ Size: Diameter-------------------------- -----------De Depth -------------- - ,------------------------- <br /> p - _� Liquid Capacity- • --------------------r-gals. <br /> Privy: Distance from nearest well----------------------------------------------_-Distance from nearest building......____.----....,.--_.___-.----_----. <br /> ❑ Distance to nearest lot line..............._______....____-.------------ <br /> ------J. ------------------------------------------------------ ---------- <br /> Remodeling and/or repairing (describe):-------------------------------------- ----------------------------------------------------------------------------------------------------------------- <br /> y <br /> ---------------------------•_---__-...-----------------•._-----_-----------•------------_------------------•-----••.•---...----------------.........-----------•----.....-.--.-.---..-.....--.--------------------------------- <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 andee ulations of the San Joaquin Local Health District. <br /> 7 -------------------------------- ----------------------------------y---- i--------(Owner and/or Co f art <br /> By:----------------------------------------------------•------------------------------- ---- - (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 DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ! ,------------------------------- ------------------------------------------- DATE......� <br /> REVIEWEDBY----------------------------------------- --------------------------------------------------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------•---------------------------------- <br /> ------ DATE----------- <br /> --- <br /> ----_--- <br /> ------------------------------- <br /> -------------------- <br /> ---------------------------------------------------------------------- <br /> -------- <br /> --------------------- <br /> Alterations and/or re -- - ------••-------- __ ------------------------------------------------------------------I•-----------•-•---•---------- ---------------- <br /> ------------ <br /> ------------------------ <br /> --- <br /> - <br /> , .t. 7►N � _c`'� c'Q_ ------------------------------------------------------------------------------------------------------------ <br /> -------------- ---- r-- <br /> ----------------------------------------- ---- --- -- -- ---- - -f <br /> FINAL INSPECTIC3N,B)' --•----- --•- ---- '! Date-------------y3-� -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1. 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M , Revised 1.57 F.P.CO. <br />