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c <br /> \ APPLICATION FOR SANITATION PERMIT Permit No. 1.6A._.. <br /> (Complete in Duplicate) Qy <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health Distric or permit to construct and install the work herein described. <br /> is application is made in compliance with County/Ordinance . 49 <br /> JOB ADDRESS AND CATIO ---______ __tel,-_�_-__ __ <br /> - ----------- -- --------- - <br /> -- ----- - -------- --�------- --------------------Phone_-_._--- ------------------------ <br /> Owner's Nam , ---- -="'- ----- ,�- <br /> -- -- - -- --- -- - --------- --- -----1-------------- <br /> ---- 6 `3 <br /> Address- -- ----- ----------- -------- <br /> - - -------- --------------------•-- •.----••--..--------------------••-.................... <br /> Contractor's Name--------- --- -- - _ ----- --- = Phone _.— ice <br /> - ------- -------- -- <br /> - -- ---- -- - - - - ----------- - -------- -- <br /> Installation will serve: Residence Apart nt House ❑ Commercial ❑ Trailer ourt EF] Motel Other ❑ <br /> Number of living units: ---/ Number of bedrooms ct_ Number of baths _/-_- Lot size _____-- _ <br /> Water Supply: Public system ld- Community system ❑ Private ❑ Depth to Water Table,6_ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeZ Hardpan ❑ <br /> Previous Application Made: Yes ❑ 1\16�- New Construction: Yes No ❑ FHA/VA: Yes ❑ No-Er <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 we_l_l.� Y2 -- __Distance from fou ation_-�-•U <br /> .........Material---_-�----L�-- <br /> No. of compartments__ 9-----------------Size___ Liquid depth___s____--_-`____-Capacity...... <br /> -------------------- <br /> ..... <br /> Disposal Field: Distance from nearest weil,_­?� _Distance from foundation__,,��J___ ____Distance to nearest lot line-_____---_ <br /> Number of lines..--------/-------____ __ Length of each line------------- -------Width of french-----f�--- <br /> _------- <br /> ---------- <br /> Type length -------------_-----_-- <br /> ---- <br /> r <br /> Type of filter material• _ _ ___________Depth of filter material____�. .�� __ g <br /> W <br /> Seeie Pit: Distance to nearest well_ '___Distance from f ndation_ ....._ istance to nearest lot line__.�`-_---___- 6' <br /> Number of pits Lining materiah Size: Di etasbepth-•-------; <br /> Cesspool: Distance from nearest well_________________Distance from foundation.-------------------Lining material----------------------------- %rrj <br /> ❑ Size: Diameter------------------------- ------Depth-------------------------------------------------Liquid Capacity---------------------- gals. , <br /> s <br /> ivy: Distance from nearest well----_--------------------------------------------Distance from nearest building----------------------- -___-__-________- 1 <br /> ❑ Distance to nearest lot line----------------- ------ --- ----------------------------------- ------------------------ ---•---- ------ <br /> U <br /> Remodeling cllor repairing (describe):----- -- ----------- ---- -- ------- --- <br /> - <br /> ----------------- •---_---_ r - ------ .......... --- .......... - <br /> ------- ------------------•-------------------------------- <br /> he y cer ify that I have prepared this applicatio and t the k will be done in accordance with San Joaquin County <br /> ordinances, State s, an r s and r gula ' ns of the n J quin L I Health District <br /> (Signed)------------- -- -- -- -- -- -------------- ---------- <br /> - ----------- -- -(Owner and r Contractor) <br /> By:--------------------------- ------------------------------------- --------------------------------------(Title)----- <br /> (Plot plan, showing size ofof t, location of system in relation to wells, buildings, etc., can be placed on reve se sid . <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------- ---- ----------------------- ------------------------------------------. DATE <br /> , ` - <br /> REVIEWEDBY----------------------------------- - ---------------------------- ---------------------------------------- DATE y- -- ----------------- <br /> BUILDING PERMIT ISSUED--------------- <br /> ---- ------------------------------------------------------------------------------ DATE <br /> ----L ------------------------------------------------- <br /> Alterations and/or recommendations. - ------------------------------------------------------ <br /> --------- - --- <br /> O <br /> ---------- --------- . <br /> - <br /> ------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- <br /> --- - <br /> FINAL INSPECTION BY:---- ---- ------ Date------- ------ ->�Y--✓ <br /> y, ------ <br /> SAN',JOAQUINLOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West.Oak Street 132 Sycamore Street 014 North '`C"Street <br /> Stockton, California Lodi, California Manteca, California Treey, California <br /> ES-9-24,-, Revised 1.57 F.P.CO. �� <br />