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aa <br /> APPLICATION- FOR SANITATION PERMIT ('er`nit No. -•- <br /> '\ (}�a� (Complete in Duplicate) Date Issued <br /> Appli cation is hereby made to +he San Joaquin Local Health istrict fo permit to constru d install the work herein described. <br /> This application is made in compliance with County Ordin ce No. <br /> r '�- -_ .. "-r'J------------------- <br /> JOB ADDRESS AND LO TION------ ----ki- -- -•----- �e��-F---- ---------------------- ------ -- ---------- <br /> Owner's Name-------- -t---- =_�rlp_ + s►-- - Phvne7 -.._..lT` 17� <br /> Address--------; - ---- --------- ----- ---•---------------------- --------------------------------------------------------------------.---------------.--- . <br /> Contractor's Name----F��1 --------------------------------------------------- -------------------------------------------- Phone_ -lQ__,,�;, 0 <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ <br /> Number of living units: --/-- Number of bedrooms _-_ umber of baths <br /> ------ Lot size ------ __1__ ~-^ -.---------_ <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth to <br /> Water Tablo <br /> Character of soil to a depth of 3 feet: Sand • Gravel []� Sandy Loam E] Clay Loam ❑ Clay E] Adobe Hardpan ❑ <br /> Previous Application Made: Yes E] No [ New Construction: Yes E] No E] 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 /> otic Tar�lc Distance from nearest well-----------------Distance from foundation------------------ Material----.----------.---_------.----_----..-----_----. <br /> -� No. of compartments------ -------------------Size--------------------- •--------Liquid depth---- ---------------------Capacity--------------- <br /> isposal Freidc Distance from nearest well.-A 6�._Distance from foundation-_,� ---------.Distance to nearest lot line - <br /> --. <br /> I _� Number of lines--------- --____-___-_- -- Length of each ---------Width of trench---_� `-'-----_--_-- <br /> ..y <br /> Type of filter materia <br /> l-�s- _Depth of filter material_-_--- '_�----Total length--s _-------------------------- <br /> .. �, fir—. <br /> -Seeprag Pit Distance to nearest well_HCk�___-_DiCial <br /> .orri ndation_�Q__ ___--.Distance to nearest lot line_--------------- <br /> Number of pits___-t_------------Lining mat --Size: Diameter_12U -------.Depth--g�_-��-------------- <br /> A\� r <br /> Cesspool: Distance from nearest well-----------------Difr oundation-_-!------ ----.Lining material_-.------------------_--.-.----_.----. <br /> ❑ Size: Diameter---_ -------------------------------Depth------- ------------------- -------- ------Liquid Capacity----------------------------gals, \ <br /> Privy: Distance from nearest.well----------------------------------_---------- -Distance from nearest building------------------------------------------ <br /> CIS <br /> F1Distance to nearest lot line------------------------------------------------------------------------------- ------------------------------------------------------------- <br /> Remodelingand/or repairing (describel--------------------------------------- ------------------------------------------------;----------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------'------------------------ ------------------------------------- -------------------------------------------•---------------------- <br /> ----------------------------- ------ -----------------------------------------------------------------------------------------------------•----------------------------------------------------------------- --- - <br /> I hereby cettify hat I have,,,prepred this application jn4 that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta1_4 s, andlrul�s and.regulations of the San/J aqui !L'ocal 1­141th District. <br /> ---------- ------------------ - -, <br /> (signed) _ � / Oaend�or �;onactor <br /> BY:----------------------------•-------------------------------------- ----- -----------f :� -.----- ----(Title)- �-- - ----- - ---------- <br /> (Plot plan, showing size of lot, location of system in relatiohIf wets, buildi gs, etc. can be placed on reverse side). <br /> FOR DEQ TMENT USE ONLY <br /> APPLICATIONACCEPTED BY--------------------- -----------=-- ------------------ ---------------- ------=------------- DATE------------------ x�}' --------------------------- <br /> REVIEWEDBY------------------------------------------------- -- -------- - - -----------------------------k--------------------------- DATE------- -tl...------------.-.---------------------- <br /> BUILDINGPERMIT ISSUED--------------------------- --- -------------------------------------------------------------- DATE.. - <br /> Alterationsand/or recommendations------------ ------ ----------•----------- --------------------------------------------------..-------------- ---------------------------•-------- <br /> ---------------------------------------------------------------------------------------------------------------------------- ------ ------------------------------------•---------------------------------------- <br /> - ------- ---------------------------•------------- ------------------------12' �Q =� fir ti „ <br /> ------------------------- , u <br /> FINAL INSPECTION BY:.------- - _ Date f-� J/J 1 <br /> (,SAN7- ------------------------------ <br /> 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 />