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,�i -.. -Y --------- 7 3 <br /> G' _ APPLICATION FOR SANITATION PERMIT Permit No. ...�,�.�t...-��6 <br /> ------------ - -------------------------------- -- --- (Complete in Duplicate) r4 �f <br /> Date Issued <br /> -_........---------------.----------------.-.----------- This Permit.Ex ire 1 Year From Date Issued <br /> ._.......�d4._�� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1 <br /> This application is made in compliance with County,Ordinance No. 549. <br /> Y de4--lu <br /> JOB ADDRESS AND LOCATION......... 1 --, <br /> ---------•--•- -----------------•--••-•. <br /> OwnersName------- �� .._ ----------------•-----••-•------.. ------------ -------------------......................... Phone------------------------------------ <br /> Address /4--- <br /> Address. ---- ' , . <br /> Contractor's Name----••---------- -• fL u�P2--------------------------------Z---------._: - Phone. <br /> Installatiion will: serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..... Number of bedrooms ..2,. Number of baths -_ :_•.Lot size /I WE4........------------------- + <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ., ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑� Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff Hardpan ❑ I <br /> Previous Application Made: (If yes,date--------------------1 No New Construction: Yes ❑ No E3 FHA/VA: Yes ❑ No 3-» <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` <br /> Se fir. 'tank:- Distance from nearest well-----------------Distance from foundation--------------------Material--------------------------------0................ � <br /> No. of compartments---------------------------Size-------------------------........Liquid_depth--------------------------Capacity....................... <br /> D's osel Field: Distance from nearest well------f------------Distance from foundation....................Distance to nearest lot line................. ' <br /> �5'T k1f Number of lines-----------------------------------Length of each line----.-_---------------....._-.Width of french..................•---------.------ <br /> Type of filter material-------------------------Depth of. filter material--------_--------------Total length...........................__............. <br /> Seepage Pit: Distance to nearest well----------------------Distance;-from foundation_l4-..........Distan a to nearest lot line....-...-__.___.. <br /> Number of pits.......o9-----------Lining material_/���.�_.-----Size: Diameter_. -------Depth__Ae - --.------- <br /> � <br /> Cesspool: Distance from nearest well.................Distance from foundation--- <br /> ,----------------Lining material.._-----.-_-__------------_-_--_-__. <br /> ❑ Size: Diameter----------------------------•---------Depth----------------------------------------------------Liquid Capacity---------._................gals. <br /> Privy: Distance from nearest well---------------------------------------------------Distance from nearest building-------------------------._--.._____.._.- <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------.......--------- <br /> l <br /> Remodelinsg,pnd/or repairin (d tribe .__-- __- - -----. = C .. <br /> �"� 1 - -•-••----------- •-- •- -------------------•----------------------------- -------- -----------" •--••--••----- <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 and regulations of the San Joaquin Local Health District. <br /> (Signed)------------------------- -• {0wa&*.&a&A*r-Gontroctor1 <br /> By:_......................------------------------------------------.-....-.. ------4, ------ {Title} CS?Ts - <br /> (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT-USE ONLY +^�, <br /> APPLICATION ACCEPTED BY------ ------- DATE-----fes �.r--•---•-------------- <br /> REVIEWEDBY----------------------------------- ------------------------------------------------•----......------------ DATE------------------•-----••--------- <br /> BUILDINGPERMIT ISSUED------------ -------•-------------------------------------•---- --------------------------------- DATE------------------------------------......................... <br /> Alterationsand/or recommendations:-------------- ----------------------------------------------------------------•---------••-•------------•---••--•---••-•------••-•---------------------------- <br /> -------.-.-----------------------•---•--••---------- ------------------------------------------•---------------------------------------------------.-----------------------------------------...................... --------- <br /> -------------------------------____......­­... ---------------------------------------- <br /> ---------------------------------------•-------•------........-.---------------------------------------••---------------------------------------------•---------------------•----------------------------------------------•-------- <br /> ----------------------------------------- -------------- ------_-- - --------- ------------•--..._..----•------...........-- ------------------------------------ ......... ... <br /> FINAL INSPECTION BY------------ ---- -- A.--__ ----------------------- Date----- � ----------- <br /> r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycpmore Street 205 West 9th Street <br /> Stotktan,Colifocnio.' _ Lodi,California } y Manteca,California Tracy,California <br /> ES 9 REVISED S-a9 2M a-BI ATLAS <br />