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J -57 ,c �G i. - y Z Z <br /> __ ______ _______. /f� .-._____.__� APPLICATION FOR SANITATION PERMIT Permit Na. __... <br /> --�---- ��/ 6-Z_ <br /> 1� .. <br /> (Complete in Duplicate) <br /> . This Permit Ex ires 1 Year From Date Issued 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 in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION............ ------------��/�.............................. <br /> Owner's Name_______________ <br /> fIQ3f'/.r E Phone...................................... <br /> Address---------------------- <br /> Contractor's Name-------d - ---•-- _ _ l �ic��./ ---aT-....1�_-_•__ .Ll�t...................... �f7ll fir,. , . <br /> Phone_ <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ./--- Number ______ _ <br /> of bedrooms __ Number of baths __ -__ Lot size __..___-. <br /> Water Supply: Public system Vommunity system ❑ Private ❑ Depth to Water Table 6_0! ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--`H' ardpan ❑ <br /> Previous Application Made: {If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ 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 /> $ i Distance from nearest well_________________Distance from foundation-------------------Material................................................. <br /> No. of compartments-----------------------_Size---------------------------- Liquid depth--------------------------Capacity------------....------. <br /> o ield: Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. <br /> 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___iAx_A_Q----Distance from __ - <br /> foundation -...__..Distance to nearest lot line---- <br /> Number of pits------/-.----------Lining material.��cT---------Size: ameter__v.,3r0_-`-�'__--.Depth__aZrr.!•--------------- <br /> Cesspool• Distance from nearest well----------------- from foundation--------------------Lining material._______--_.____-----.---_____.._--.. <br /> ❑ Size: Diameter--------------------------------------Depth--------------------------------•-------------------Liquid Capacity-------------- .............gals. <br /> Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line---------r-------------•--------------------•---- <br /> Remodeling and/or repairing (describe):---------------------- ------------------•---•-•-•-----•----------...........................-------------------------------------------------------- <br /> ---------------•--•-----•-------•------•---------------------------------------------------------;- <br /> ------------------ <br /> -------•_....--------------------- <br /> -•-------------------- <br /> --•-• --- - --- --- 1 <br /> •-•----------------------------------------•----••-----••-•------------•-----------------------------------•-------------------------------•---------------------------•------•-----•-----•---•--------•--•---------------- <br /> I hereby certify that I have prepared this application and that the ork will be done in accordance with San Joaquin County <br /> ordinances, S a e laws, and rules and regulations of the San Joaquin L cal Health District. <br /> . - <br /> (signed}.-•- ! ( F ..+. ---------------------(Owner and/or Contractor) <br /> By:.................................................-------------------------------------'---` -------- ------------(Title)--- -------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relatio o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ --t -- C-P- -----------•----•---------------------- DATE... �� '..—2— <br /> REVIEWEDBY------_--_----------------- ----- � -----------------------------------------------. ------------------------ DATE-------••--•------ <br /> ---------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------– ... ------------------------------- DATE------------------------------------------- <br /> Alterations and/or recomm ndationg--------------- - :--- - -_- _-__--_-.___..____.__.-_---- <br /> < _ <br /> -----. ----r4 :tn_�C-T.._--- .t ;-��-- - . <br /> ---------------------------•--------------------------•---------------------------------•--•....----------------------------.----------------...------------------------------ <br /> ------------------ -------- ---------------------­------------------------------------------------------------------------------------------------------------------ ---------------------------------------- <br /> FINAL <br /> •- --- <br /> -----------------------------------------------•----•-----------------------------------•- --_.._...--------- <br /> FINAL INSPECTION BY:.C.- --•---__--------- Date---: ✓� �`� 2 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-99 2M 3-61 ATLAS <br />