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APPLICATION FOR SANITATION PERMIT Permit No. /d7__16 . <br /> 42-10 (Complete in Duplicate) 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 Ordinance No. 549. <br /> - ---- ----- <br /> JOB ADDRESS AND LOCATI ............. <br /> f <br /> Owner's Name----------------------- (•t ` Phone <br /> Address---------- t4'* <br /> . <br /> � ` <br /> j <br /> ---------------------•..--------•--•------------------------•----------- <br /> ; 'Contractor's Name------------- --------------•--- -----------G6 <br /> - -----•----• ----------...----.... Phone--------------------............... <br /> Installation will serve: Residence 0'"Apartment House E] C mmercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: �'%__ ._. Lot size __- �___r ..--/_.r__�------_---------------------- <br /> Water <br /> ______________ <br /> �--___ Number of bedrooms __:._ Number of baths _� ____-__--__ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .=:___ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q---fardpan ❑ <br /> Previous Application Made: Yes ❑ No �New Construction: Yes ❑ No ET__­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 Tank: Distance from nearest well-----------------Distance from foundation--------------------Material______-_-___--.-_--.-_.__-__----__._-_.-___-__. <br /> ,: r: a _.__. . ..- ._. . ________________________ ______Liquid de th __-_-__----_ -Ca aci <br /> Capacity <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- O <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench---------------------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ <br /> Seepage Pit: Distance to nearest well /� _ _..__Distance om foundation___L'_'_'_..__..Distance to nearest lot line __` /..----- <br /> �_ Number of pits.._': -' __. ..------Lining material-_- . P.:_ -._____Size: Diameter--a- :'-----------Depth--/,.------- <br /> epth- _,__f.__ ` VVV <br /> Cesspool: Distance from nearest well_---------------Distance from foundation--------------------Lining material------------------------------------- <br /> ❑ Size: Diameter--- ---------------------=-----De th---------------- --------------------------._Liquid Capacity gals. <br /> Privy: Distance from nearest well_______________________---___-.-__---.__-_.-._Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line------- --- --- !- -------- `----- ---'- <br /> Remodeling and/or repairing (describe) ^ - _ _- = -- ---_-------- - _-- <br /> -------------------------------- fff <br /> ' -vti,�' �-• =l -----'fes Ff'r`--- - ---------------------_-------_----------- <br /> ------------------- <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 and regulations of the San Joaquin Local Health District. <br /> (Signed)-------------L . ----------. �= -�-'------------------------------------------------------------ <br /> (Owner and/or Contractor) <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--- �' ___i <br /> r_=:� ` <br /> ------ ---------------- <br /> -------------- DATE DATE---------�-----'�=-----='-,�--------- <br /> ----------------- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE----------------------------- <br /> BUILDING PERMIT ISSUED-------------------------------------- DATE---------------------_ <br /> Alterations and/or recommendations---------------------- <br /> --- <br /> y-------•------------------------------------------------------------- --- <br /> 1"' <br /> ='- ----------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- --•--- --------------------------------------------------------------------------------__.------------------------------------------------- ------- <br /> FINAL INSPECTION BY:---------------------------------------------------------------- Date------------------------------ ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 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 />