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1� APPLICATiON FOR SANITATION PERMIT Permit No..-_f-.1__..� <br />Ito <br />v: (Complete n Duplicate) «/ j <br />C CiDlit-Date Issued --- -------- <br />g <br />a- -s <br />IV <br />Application is he 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 />JOB ADDRESS AND L CATION_ ____---/ + ---_-_12546. -----__ --Y ------ ---------- <br />Owner's Name ------ _ <br />- --_v--- ----------------------------------------------- -------------------------------------------Phone------------------------------------ <br />Address-- Wil/ "� s* `------------------------------'-------------------- ----------------------------------------------------------------------------- ------ ----------------------- <br />---------- <br />Contractor's Name ='' ` ('J✓'�------------------------------------ ------------------- Phone---- -- ------ <br />Installation will serve: Residence Apartment House ❑ Commercial ❑ 'Trailer Court [❑ Motel ❑ Other E❑ <br />Number of living units: _/__ Number of bedrooms -_ Number of baths _/__ Lot size,4_e---z'------ _------------------------ <br />Water Supply: Public system ecommunify system .❑ 'Private ❑ Depth to Wafter Table'3V_ _'ft. <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gao'O'Hardpan ❑ <br />Previous Application Made: Yes ❑ No q]"' New Construction: Yes ❑ No R�-_FHA/VA: Yes F No ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />epticr,Tank: Distance from nearest well_- _,6 -_ Distance from foundation___________________ Material-___._________..______________________.________- <br />�' No. of compartments ------------------------- Size --------- = ------- -----•---.---Liquid depth -------------------------- Capacity -------------- <br />Field Distance from nearest well ------------------ Distance from foundation _--_._.-__.-------- Distance to nearest lot line ----------------- <br />6isposal6' <br />❑ Number of lines----------------------------------- Length of each line -------------------- --------- .Width of trench ---------------------- ------------- �- <br />Type of filter material_______________________ Depth of filter material ----------------------- Total length _______.____._____.__________ ___________ <br />0 <br />Seepage Pit: Distance to nearest well__?__"Distance fpm foundations __�'..Dis nce to nearest lot I-snne�___-�______ <br />® Number of pits ------/--.__-_---_-Lining material_ )____.Size: Diameter-__'�"�-__.._---___.Depth-_-____________________ <br />Cesspool: Distance from nearest well ----------------- Distance from foundation -------------------- Lining material ------------------------------------- to <br />❑ Size: Diameter-----------------------:-----------.Depth--------------------------------------------------- Liquid Capacity ---------------------------- gals. ? <br />Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building ------------------------------------------ <br />F1 Distance to nearest lot line-- -- ----------------------------------------------------------------------------------------------------------------- --- <br />Remodeling. <br />-- <br />Remodelin and or re airin describe ----------------------�� ��=�'----------------_---------------.---- <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)---- =--------- ----------------------- ----= --=- -- ----- Ovwner,2-p� r Contractor) <br />n o or <br />By: --------------- ------------------- ------------- `� C ----------------------------------------- {Title)------. �'-`-- - <br />----------------------------- <br />(Plot plan, showing size of lot, location. f system in relation to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY---- --------------------- ---------------- ------------------------------------------------ DATE ------------ <br />--------------- ---------------- <br />REVIEWEDBY---------------------------------------------------------------------------------------------------------------- DATE ------- l -a0- ------------------------------------------------ <br />BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- DATE------------------------------ --- <br />Alterationsand/or recommendations: ------------------------------------------------------------ --------------------------------------------------------------------------------------------------- <br />------------ --------------------------------------- ---------- I --------- --------- I --------------------------------- <br />,`� R_ <br />FINAL INSPECTION BY:___ _ i" `----______________________ Date ----- I-- - <br />130 South American Street <br />Stockton, California <br />ES -9-2M , Revised 1.57 F.P CO. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Lodi, California Manteca, California Tracy, California <br />