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APPLICATION FOR SANITATION PERMIT Permit No. 1_G. _.7_ <br /> (Complete in Duplicate) 3 <br /> Date Issued __.___.Ily���. <br /> Application is hereby made to the SarilJoaquin 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. 544. <br /> JOB ADDRESS AND TION---___- -7 -9 ----- ----- ------------------------- <br /> z <br /> �- - j �f� ` - r <br /> Owner's Name-------------------- -------M fw-7-11-------------------- -- Phone------------------ ----------------- <br /> Address----------------- <br /> ---------Address--------------•-- ! M ------- ------------------------=------------------------------------------=---------------=---....-------------------------------- <br /> Contractor's Name------------------- 17_ ` - --_-, -- ' 1-SfI -_,a� Q /S-- <br /> / ---- .---------- Phone_ <br /> % <br /> Of <br /> Installation will serve: Residenceouse E] E] ❑ 1]Commercial Trailer Court Motel Other [] <br /> Apartment H <br /> Number of living units'- -- _---- Number of bedrooms 2-- Number of-baths _� Lot size _--_--Z-7 -r-47------------------ <br /> Water Supply: Public system Comm un'ity'systern ❑ Private ❑ Depth to Water Table 6 ft. <br /> Character of soil to a de fh of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan <br /> P ❑ ❑ Y ❑ Y ❑ Y ❑ ❑ <br /> Previous Application Made: .,Yes ❑ No New Construction: Yes E] No FHA%VA: Yes E] N� <br /> TYPE OF INSTALLATION AND SPECIFiC`ATIONS: I <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ' <br /> apt c v <br /> No. n co from Distance from foundation__.-.-------- ---.-.Material------------------------------------------------ <br /> Distance from nearest w T _ _^ <br /> :I - Size--------------------- .---Liquid de th---------------------- Capacity <br /> Dispos Distance from nearest well-----------------Distance from foundation.- __.--------------Distance to nearest lot line----------------- <br /> JI✓ mLength,of each line--------------_--- Width of trench----------------------------------- <br /> ` r Type of filter material--- _______________Depth of-filter material----------_-------___ Total length--------------------......_..___v__ <br /> See pa e Pit: Y Distance to nearest well__ '/ i___ Distance om foundation_„�s.5__t_---- a'nce1 nearest lot line-__-j ..___r_-- <br /> Number of pits___.. _._._____.__:Lining material--- .__.S¢e. Diameter .________.Depth- �-----_ `� <br /> Cesspool: Distance'f3•om nearest well-----------------Distance from foundation------------------''Lining <br /> ❑ material-------------------------------------- <br /> Size: <br /> Diameter---------------- _; ---_De th--.----------- -- ---Li Liquid Capacity------------- - --------.gals. <br /> Privy: Distance;from nearest well_________________---------------------------._____Distance from Enearest building_-_---_--.__------------_--_-_--..-.----. <br /> ❑ Distance to nearest,iot-line_'---*-: '_ ------- --------- ---------=-"' <br /> �F <br /> ------ ---------------------------------•----------•- -------------------•------- <br /> `� <br /> Remodeling and/or repairing (describe):_-- ---------- -------- ------- -,. �- �J <br /> --------------• •---------------- '. - -=------- - - ----- ------------- ------------------------------------------------- --------------------- <br /> r <br /> ----------- - -- - - <br /> I ' <br /> 1 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 ulat' ns of a Joaquw Local Health District. <br /> (Signed)-----•---------- ------------------ y - -- -------- -- --- (Owner and/or Contractor) <br /> By• (Title) - ------ <br /> (Plot plan, showing size of lot, location of system in relatwon to , buildings, etc., can be placed on reverse side). <br /> L. k <br /> 4 44 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -- - ---- L^e---_ ------------------------------------------------------- DATE-------- Z 1 <br /> REVIEWEDBY--------------------------------- --------------- ---------------=---------------------------------------------------------- DATE---e------------------------------- ----------. ------- <br /> BUILDINGPERMIT ISSUED------------- ------- --------------------------------------------------------------------- DATE-------- ------------------•--------------------------------- <br /> Alterations and/or recommendations-----------------------------------------------------------------------------------­­•-----••---------------------------•------------------------------ <br /> ----------------•----------------------=----------------------------------- ---------------------------------------•-•--------•--------------=------------------•--------•--------•-------------------------------- <br /> -----------,-----,------------------------------------------------------------------- --------------------------------------------------------- -- - ----------------------------------•----•--------------- <br /> � � -- --- -- x.. ------------------------------------------------- -----_-------_._------_-_._-----.__._.__,_-----.____.__-------------------- <br /> ------------ <br /> f <br /> FINAL INSPECTION BY:.6_ ____________. 3 `f3 <br /> _ Date - _--------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> / ES-4-21x1 Revised 1.57 FP.CO. <br />