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T FOR OFFICE USE: •Y�� " <br />------------------------- <br />-------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br />---------------------•-------------- -------------------- (Complete in Duplicate) — <br />---------------- - ----------------------------- <br /> ------- This Permit Expires 1 Year From Date Issued Date Issued ....�`�._....�:_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constr t and in the work herein descried. <br /> This application is made in com liance,�Vth_C my Ordinance No. 549. <br /> rr <br /> ,JOB ADDRESS AND LOC � zc ----�_cc ---••- <br /> l�E.. <br /> Owners Name----------------•----_- - <br /> - -- <br /> Phone---------_------------------------ <br /> :.. .-.Address--------------------------------------- <br /> Contractor's <br /> Name----------------------------------------------------- .._ -------- ........................................................... <br /> Phone.----------•-------------------•--- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ___,/_ NuIribe�r of bedrooms - Number of baths 1.... Lot size ._., ... ?___________________ <br /> Water Supply: Public system ❑ ,�Co,mmunityYsystem ❑ Private�' Depth TO Water Table A `ft. <br /> Character of soil to a depth of X fee- San .❑• Gravel l] Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe[I Hardpan ❑ <br /> Previous Application Mader (If yes,date------- <br /> ---- No New Construction: Yes ❑�NOR <br /> FHA/VA: Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS; <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p <br /> l <br /> Septic Tank: Distancekfrom nearest well---af"_Q___Distance from foundation-----/-__C-------Material_ ___ ___ ___ ____ <br /> No. of compartments-------------'i1�_---Size---- �-,. Liquid dep?h------------------.;_Capacity-.._--___-. <br /> Disposal Field: Distance from nearest well---+r 0__Distance4;from foundation.____ 4._.Distance to nearest lot line.___.. <br /> Number of lines___________________ _ ____--.Length of each line----------- ._:._.Width of french-------- _.___-_-.--__SI <br /> -------- <br /> Type of filter material._.De th of filter materiaL,l__ __ '� ._.Total _length_____....- �____�-t____ <br /> Seepage P"t: Distance to nearest well___.--•.��-�________Distance from foundation__.._./_C�__--------UUDistance to nearest lot line____:_01- Number of pits.-.------___.______Lining material__-P4.��__-Size: Diameter__.!-._X_ _.:-Depth__Cesspool: Distance from+nearest well_________________Distance from foundation.-.______---_______.Lining material____._____-.________....________-Size: Diameter-%----------------------- ----------Depth-------------------•---•----------------------------Liquid Capacity----•-----•------•--....---gaPrivy: Distance from nearest well________________-________-__ _____._-_____-__-.-Distance from nearest building.-__________-_-.__________-_--______--❑ Distance to nearest lot line-------------------------------------------------------------------------•-------------•------------•----- - -•--- -----------Remodelin and/o repairipg (describe):__------ ° '7' Q I _(K��" ----,6�({ . ,. �; 1 �R P-M---------TBJ, -- ----------l�--_-...E_2.K--,...______5`�.` ____J.''__---- - -._` -__-_.__ _--..__ ' `T`,_.___.»________________________________ ___________________________ <br /> ------------------------------------------------­---------------------------------------------------- -------------------------------------r4.K02-=------------------------------------------------------ <br /> I hereby certify that I have prepared this applic tion and that the work will be done in accordance with San Joaquin Couofy <br /> ordinances, State laws, a rules and regulations of the San Joaquin Local Health District. <br /> r <br /> t 5 <br /> (Signed)---:.. ... -------- <br /> i ned -- ----------------------------------------------------------------- ----------- -----------•---=---------(Owner and/or Contractor) <br /> BY:--_------------ --------------------...........-------- ----------- = ------------------------ ------------------------ (Title):.--------------------------------------------- ----------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> I <br /> FOR TMENT USE ONLY <br /> APPLICATION ACCEPTED BYi------ �-- �------------------------ DATE-.--- ------------ <br /> REVIEWED BY-------------------•---•------------------------------- ------------------------------------------------ ------------------ DATE----------------------------------_-_-------------------- <br /> BUILDINGPERMIT ISSUED----------------------------•-------------•------------------------•-•----------.._..-----------•---- DATE------------------------------------------------------------- <br /> ANrationsand/or recommendations------------------------------------------------------ ----•---------------_ -------------------------------------------------•-------------------------•---- <br /> -------------------•------------------•---------------------------•- -- - ------------- ------------- ------------------------------•-----------•-• -----------_ -----•-•---------------------------------------•---- <br /> ------•----------------- ----- <br /> f FINAL INSPEC <br /> r Date------ --7 ._ ------------------------- <br /> -. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sveet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVlSED a-59 2M'5.68 ATLAS <br />