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r <br /> ---- -- -- --- -----�- ------- - - APPLICATION FOR SANITATION PERMIT Permit No. ._P�..-.-��.:/��--- <br /> (Complete in Duplicate) <br /> r - This Permit Expires ires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. <br /> This application.is made in compliance with County Ordinance No. 549. <br /> �° � S• �, 4,v <br /> JOB ADDRESS AND LOCATIO Xf) "" 3��� �� � /p --- <br /> --- <br /> F-----Owner's Name------------------------FhAaK------- <br /> � ® <br /> n± _ _ <br /> Address --------------------------- ------ Phone----- ------------------------------ <br /> --------MY-A&----- <br /> --------------•-------x-------MY-A&----- rA <br /> Contractor's Name--------F���___"-Roo.�+�� " <br /> - 4' -------"-----------------"---------------------------------- (;ND <br /> -------------------- ------------------------- ---- <br /> ------------- Phone------------------ <br /> - <br /> I Installation will serve: Residence B-Apartment House <br /> ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � �••�"i <br /> Number of living units: _ --__ Number of bedrooms <br /> ___. Number of baths _d�__ Lot size " /4CFI' Water Supply: Public system Community syst <br /> ❑ Private �epth to Water Table ft. ti <br /> • Character of soil to a depth of 3 feet: Sand Gravel '�4 <br /> ❑ Sandy Loam ❑ � Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date._.____ J No �New Construction: Yes ❑ No ®"IHA/VA: Yes [] No <br /> T-Y--PETOF-INSTALL-ATION•,-A,ND-SPEGIFIC•ATIONS:a w - - 1F <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.). ' <br /> Septic Tank- Distance from nearest weil-------------_---Distance from foundation___.._ I <br /> lW- -...Material ------------------------- ------- I <br /> No. of compartments- ----Size----------------------- ------Liquid depth------------- - <br /> - ---Capacity-------------- ------- <br /> disposal Field: Distance from neares# well--- -._---Distance from foundation.___./D <br /> Distance to nearest lot line___ "--_ . <br /> DD T umber of lines----------/----------------------Length of each line-----.�P1_._�_- _ rr <br /> �� ----.Width of french.._.____2 <br /> ype of filter material__RQ-C/�-------Depth of {alter material------�.�""__ --.-.Total length_._. ____.___SQ" ' _ I <br /> • <br /> Seepage Pit: Distance to nearest well-__1Q 0_-_ Distance from foundation_._"" I <br /> �Q_--"_._.DistanMc to nearest lot line----S_ .-_____ <br /> Number of pits_.._--------------Lining material--RO C-,K_"-Size: Diameter___4, -K _ " <br /> . - -- Depth-----1 -------------------- <br /> _-Distance'Cess ool: r <br /> p Distance from nearest well -_Size: <br /> from foundation------------------ material_...._.____"".______.__ <br /> ❑ Size: Diameter---- -- ------------------ Depth -------------- <br /> - ---------------------------Liquid Capacity---------------------------gals. <br /> I <br /> Privy: Distance from nearest well ___ <br /> --------------------- from nearest building 5 <br /> Distance to nearest lot line__" _..____"-__-"-___ . - '., -------- --- <br /> ----------------- <br /> -------------- <br /> a <br /> ---------------------------------------------------------- <br /> Remodeling <br /> --------------------- --Remodeling and/or repairing (describe):__________________ <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)___ ti` , <br /> ----------- ------------------------------------------- <br /> - -- ---- <br /> _: - ------------------ ---------- --------------•------------- -,-�;; - � -(Owner and/or Contractor) i <br /> - <br /> {Title) - ----- ---- - -- <br /> -------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).- <br /> - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY....---._- 'i_.R.� . <br /> RATE -� �� " <br /> REVIEWED 8Y -------------------------- ----- - <br /> ----------------- DATE----------------------------------------------------- <br /> --------------------------------------------PERMIT ISSUED -------------------- <br /> Alterations and/or recommendations:-- - -.' - . '— - <br /> A• E <br /> - ------ --------------------- <br /> ----------------- ------ •-- -- <br /> ------------------------------------- <br /> ------------------------------------------------------------------------------------- <br /> --------------------- <br /> -------------- <br /> -------------- --- <br /> --------------------=------------------------------ <br /> FINAL INSPECTI <br /> -- - --------- - <br /> Date__ -- <br /> ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street <br /> 124 Sycamore Spee! 205 West 9Th Street <br /> Stockton,California Lodi, California <br /> Manteca,California <br /> Tracy,California <br /> F•.P.C 4. <br /> ti. t <br />