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42 CY <br /> j APPLICATION FOR SANITATION PERMIT Permit No. ____ ....... <br /> (� (Complete in Duplicate) '7 l <br /> Date Issued _____!--_S ..�._ <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. + <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB AD --------4-• / I <br /> DRESSAN CATION ---- --- -- - -- ------�� - - - --------------- - - { ------------------------------------ <br /> 1! <br /> Owner's Name---- Phone I <br /> e�1 - ---- <br /> Address -- �f� �`� Y�` ----------------­---­-­ <br /> ------------------------- <br /> ----- --- -• - <br /> Name '= ------------------------- Phone----------------------------------- <br /> Contractor'sk <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Nu <br /> `mbar of living units: _/--- Number of bedrooms �--- Number of baths��_ Lot size _ - � --'--------------------------- <br /> 1! <br /> 01 <br /> Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table �,;-'ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ . Adobeardpan ❑ <br /> Previous Application Made: Yes ❑ No New.Construction: fYes �o ❑ FHA/VA: Yes P —No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (N".0 septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> P / ,`,9 <br /> Tank: Distance from nearest w�IItrlDistan�e.f m foundation---,f .... .Material _��_.-__ i� .... <br /> . . <br /> Septic a No. of compartments_-_ __ -:Size�.J_!t __1?f_t/�.--____Liquid death-= �__ Capacity.___rf,J <br /> Disposal Field: Distance from nearest well ®'' Distance from foundation_ Distance to nearest I t lin`e.a.l - <br /> �iNumber of lines_.____, ___ _. ._�. ._�_ engt.h of each lined%,��.Width of trench___ ._. . <br /> G ------------ <br /> Type of filter material// � e `th of filter material Total length 40 --, �.. <br /> " Dista10, <br /> nce f o fou anon__ .__.__,_...Distance o nearest lot line--Ia___.. <br /> Pit: Distance to nearest well---- _ _ '0� <br /> 1L�1 Linin ma#erialer�,ll --VSize: Diameter. ��..----De th----.- -°------------- <br /> Seepage Ili Number of pits_____f9_---. g _ p (� <br /> w � <br /> p Distance from nearest well_. .-_Distance from foundation--------------------Lining material_--.:.-_-- _------------------------- <br /> -------------------- <br /> -----; <br /> ------- <br /> Cesspool 11 Size: Diameter---- ------Depth--__ -- ------ -- ---- --- ----Liquid Capacity-------.--------------------gals. i <br /> Privy: Distance from nearest well-- --------------------_ _-_-__Distance from nearest buildin <br /> ❑ 9 <br /> ----- ------------------------------------- <br /> riv Distance to nearest lot line----- ----- .1 ----- -------------- <br /> Remodelil <br /> ng and/or repairing (describe):----- --� �� =-- - - --- - --- -------•----------------------- ---•------ <br /> -------------- --•--------------------•---------------------------------- ----------------- -------_-_------------- -------------------- --_---- ------- <br /> i <br /> =--------------=-•-----------------------------------------------••-=--------------------------'-----------------------------------•------------------------------- •--•----------•------ <br /> - --------------------------I----------------------------------------------------------- --------------------------------------••----------------------------------------------------------:--------- <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 lawaandlesand reg lations of the San Joaquin Local Health District. <br /> Signed_I' . ( Contract ) <br /> Co or <br /> Y------------------------------------------------- ------ -------- - - ---- - = ---------- (Title) / ------------ <br /> (Plot plan, showing,size of lot, locat' of system in relation.#o wells, buildings, etc., can-be placed on revers ide). <br /> FOR DEPARTMENT USE ONLY <br /> TION ACCEPTED BY----------------------------- <br /> - ----- -- - - ------------ - -- ------------= DATE , -------- ------------ --------------- <br /> REVIEWED <br /> -- - - -- <br /> APPLIC ED BY DAT __ � , <br /> - ----- -- ----- ------ ----------- ------------- <br /> REVIEW - <br /> BUILDING PERMIT ISSUED-------- ----- - - ------ ------ --- ----. DATE ---......... <br /> Alterations and/or recommendations:------------------------ - -------------------------------- --------- ------------------ ---- -------- --------------- ------- <br /> ­- <br /> -- -- , <br /> -•- --- r r 1-� -- --- h <br /> . 1 ---- 1- `F ' r'2---- ®-- fi ... ` <br /> �•---------------- --=------------------------'-----�----------------------------------------------------------------------------------------------------------------._.... <br /> --------------------------- ----------- --------------------------------------------------=------ ---------------------------------------------=---------- <br /> FINAL',:INSPECTION BY:-----4v _,n----- ---------------=-=------ Date------- ------- - --------------- ---------------------------- <br /> N SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> S+ockton, California Lodi, California Manteca, California Tracy, California <br /> 2M Revised 1.57 F.P.CO. - <br />( ES-9— _ <br />