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FOR OFFICE USE: _ II <br /> ---------- --------------------- - J �( <br /> Ic, 3-c- - ------------- APPLICATION FOR SANITATION PERMIT Permit No. ....�___.____`.......... <br /> ----------------------------------------------------- (Complete in Duplicate) <br /> Date issued .Z d__�:_.:3.`.'_ <br /> - <br /> --_--_---------------------- ----------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is`made incompliancewith ounty-Ord inonce No. 549. 19 ' -. <br /> , f , r-------- ------•- <br /> X <br /> .. '"JOB ADDRESS AND LOCATION......... <br /> Owner's Name---- --- ------- d - - -----------------------------------------------...--------------------- -- --- Phone--•.--------r----`_�--"--"---�----'-�-•`- <br /> - <br /> -� <br /> Address----- ----•-•------• :01----------- --- ---------------------------------------------------- -----•-.........._-...................... <br /> k. <br /> Contractor's Name--------- ------------ --•---------- --•----- Phone-----•-••--•------- <br /> r <br /> Installation will serve: Residence Apartment House ❑+ Commercial ❑ Trailer Court C1Motei ❑ Other ❑ <br /> � A----- �.1—�-----••----------------•- <br /> Number of living units: __�_. Number of bedrooms __ANumber of baths __.�_. Lot size ...`__ <br /> Water Supply: Public system ❑' Community system ❑'�Priva+e �epth To Water Table lfJ_ft <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,dote--------------------) No R��\New Construction: Yes ❑ No W2-"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 /> Se tic Tan :. Distance from nearest well---------------.-Distance from foundation_______________-__.Material--_-___________-_______---.._.__________________- <br /> No. of compartments-------------------- ---Size------------------------•--:---Liquid <br /> ggdre��..---,----------------Capacity------------------- <br /> Disposal Field: Distance from nearest well.1,40_-_Distance from foundation...> IL;e_..._.__.Distance to nearest lot line._AW._-. <br /> Number of lines.... ____ ___ __ Length of each line,._ Width of^French___r.2 _________-.------ <br /> Type of filter material _Depth of filter material____�4P__-______Total length........��__-----__g__.________.__ <br /> 01 01 <br /> to ce to nearest lot line_.. .�_. <br /> Seepage Pit: Distance to nearest well----/AQ----Distance fro foun. ation____ ___ <br /> Ln <br /> Number of pits--..--/-----------Lining material__._ - _-Size: Diameter._,��.���___..Depth_.��.---_----•---------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__._ ___ _______.Lining'rrlaterial:____ _____.________.....___......... <br /> ❑ •' �-----;_---_Li Liquid Ca oci .......gals. <br /> Size: Diameter--------------------------------------Depth------------------ ------------------------------ <br /> ----------- <br /> -------------- -- q P tY r = <br /> sr <br /> i Distance from nearest wet!_________________________________________________Ditance from nearest building___-_'�__________-I--­-------------- <br /> Privy: Distance to nearest lot line----------------- --ve <br /> ----- <br /> Remodeling and/or repairing (describe) <br /> ------ .....4_..a <br /> --------------------------------------- -----•--•----�----------••---------------------•---------------------•--- I <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 5nd regulations of the San Joaquin Local Health District <br /> q aF <br /> i (Signed)----------------••------ ,��` = <br /> Qor Contractor) <br /> Ti+Ie <br /> ll, �_'_..... <br /> BY�-------••----------------------------------------------- --- - { <br /> (Plot plan. showing size of lot, location of system-in.rela ' -to-wells,-buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ' ------------------------------------------ DATE---- 3 �� " r ------ <br /> REVIEWEDBY------••-------------- ----- --------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED-------_---•-------- ------------------• DATE----------------------------------------•----•---------•----- <br /> Alterations and/or recommend ions---------------------- - ---- ----------- y----••--------­----------- ..... • ...................... <br /> ---•------ •---------------------------------------I—------------------------------------------------------------------------- <br /> ­1--- <br /> ------------------------------------------- <br /> �h ------- -------- 7 <br /> (A <br /> FINAL INSPECTION BY:----S�; ------------------- - ----- dl �1�` Date---- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ' <br /> - <br /> 130 South American Street 300 Wed Oak Sonet 124 Sycainon-'vet ti ROS Westt-9th Street <br /> Stockton;California Lodi,California Manteca,California d Tracy,California <br /> -" ES 9 REVISED 8-99 2M 5-62'ATLAS <br />