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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> �... Date issued ---5/6j5-9_.___ <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 in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCA• ION----- -- afttr--•----------------- -------------------=----------------------------- --------- ---------•-•------------ <br /> Owner's Name---------(Mc - ;6I <br /> 014 -----•--------------`---------------- ---- - --------------- ---- --------------- ------------ ---------- Phone-- ---�0•----------te-l---$--_� <br /> --------- <br /> Address523 <br /> ; <br /> 5 -Q _..Qwtro e------------------------ - <br /> Contractor's Name------•-•-•- c ------------------------------------------------------------------------------------------------- ---------------- Phone----------------------------- <br /> Installation will serve: Resid nce In Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> I�; 1 y, <br /> Number of living units:..------ Number of bedrooms --_-3- __ Number of baths __ __ Lot size --_ 160_____________________________._______.____ <br /> IM° <br /> Water Supply: Public system M Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth`6f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ <br /> Previous Application Made: :IIYes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No 9V <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance I from nearest weII_tM(!------Distance from foundation--------10------.Material __Ite#11wood__________________________- <br /> 1N No. of compartments----------2-------------Size------- -—----------Liquid depth--------4----------------Capacity__800------------- <br /> Disposal nearest well-MIX------.Distance from foundation___-d@----______Distance to nearest lot line----------------- <br /> Number <br /> ____ _______ <br /> Dis osal Field: Numberl�of lines :3 .f ------- -- Length of each line_jWa,,3W*50....Width of <br /> ) trench_-_-24______________________-_- <br /> Type ofilfer material______r0_0---------- of filter material____A$ ---------Total length_---250------------------------------- <br /> Seepage <br /> ______________________________ <br /> See age Pit: Distance <br /> \ <br /> to nearest well---------------------- foundation--------------------Distance to nearest lot line-----__________._171 <br /> \ ' <br /> Cesspool: D stancelof pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- <br /> `from nearest well-----------------Distance from foundation--------------------Lining material__.______-___________---_-_-__-__---_. 0 <br /> ❑ Size: Diameter------------------------- -----------Depth-------------------- ----------------------Liquid Capacity--------------------------gals. <br /> Privy: Distancejrom nearest well---------------------------------------- ---Distance from nearest building-------------------._____-_---------___._. <br /> ❑ DistancelIta nearest lot line------------------------------------------- ---------------------------------------=---------- --------------------------------- ------------ <br /> Remodeling and/or repairnlg (describe]:_•_.__.....tthatd_�# -- u$ <br /> ----------------------------------- 1€ •- - = <br /> --.._•------- -- --------------------•--------------------------------------------------------------------------- <br /> iM ---------------------------------- <br /> IN <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 J "quip ocal Health District. <br /> t <br /> (Signed)L _/_—.__.l ' *------------------------------(Owner and/or Contractor) <br /> r <br /> Title <br /> By:---------------- -- <br /> --------------------------------------- ---------------------------------------------------------- ---------- ( - - - <br /> (Plot plan, showing size of lob, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTEDBY------------------- --------------------------------------------------------------------------- DATE-------- OY--0+---1$109------------------------ <br /> REVIEWEDBY-----------:-------------------- ---- -.---- --- ----------------------------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED1---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations---------------------------------------------------------------------------------------------•-------------------------------------------- ----_----------- <br /> . <br /> I€ - ------------------------------------------- <br /> -•----------------- -------------------------------------------------- ----------------------------------- -- -------------------------------------------- <br /> n�: <br /> IN -------------------------•----•----------- <br /> ----------------- ------------------------------'--------------------- ------------ ------ --------- ----- <br /> FINAL INSPECTION BY:-.------ _ -- Date_-- _- _�_ -----------------­­---------------- <br /> SANJOAQUQUIN 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 /> a <br /> ES-4---2M , Revised 1.57`F.P.00. ` <br /> I <br />