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/�R OFFICE USE;1711 <br /> APPLICATION FOR SANITATION PERMIT Permit No. .___._-.- <br /> ----------------------------------- -- <br /> (Complete in Duplicate) l L 6 S <br /> Date Issued ___ __ __________ _ __ <br /> .__._-._____ ---------- --------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District far 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 LO _ d= 1 --� � <br /> _ ---------------------------- -------------- -------------- <br /> Phone <br /> -------------------Owner`s Name------------- __Ayr-------- <br /> Address__ _1.._� -a'►.ls__2- ---- " 1.-��''�'"+ ----- -- ------------•-----------------•------•----.-----.----------- <br /> �/ , <br /> Contractor's Name--__.__- .l-� �• <br /> - = 1 . - -. Phone <br /> Installation will serve: Residence ©- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1____ Number of bedrooms _,;F*--- Number of baths __Z._ Lot size ._ ____. c2_ ---------------------------- <br /> ' r <br /> Water Supply%,Publicysystem ❑ Community system ❑ Private [j- Depth to Water Table <br /> Character of soil to a depth of 3 feet: iSand ❑ Gravel ❑ Sandy-Loam ❑ Clay Loam ❑ Clay ❑ Adobe V- Hardpan ❑ <br /> Previous Application Made: (If yes,date,__. --------I No 93-"New�`Construction: Yes E�'No ❑ FHA/VA:-Yes No ❑ 6� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: max' <br /> (No septic tank or cesspool permitted if public sewer is available within 206 feet.) <br /> Septic Tank: Distance from nearest ----_Distance from foundation'--_/..............MaterialW_ -----.-------- <br /> {� <br /> f;_ <br /> No. of compartments------4----------------Size--�--X�_X%-----Liquid depth------ -.------------._Capauty__.�a-.- <br /> Disposal Field: Distance from nearest well__4_.P . Distance from foundation- /!_----------Distance to nearest lot line-4C--------. <br /> ©/ Number of lines.--.-------- -------------------Length of each line------?......................-Width of french... - --.--------------------- <br /> r� <br /> Type of filter material--------dx?4 __Depth of filter material_____/ ---- length-------__-1�'S-:d------------- <br /> ------- <br /> Seepage Pit: Distance to nearest well---ZQ_�_f-----Distance from foundation___/-�`_._-_------.Distance to nearest lot line_..------.- Ig <br /> Number of pits------2------------Lining material--- Diameter.--,7; -.(_'_--------Depth-.--1,i-`---------------- <br /> Cesspool: Distance from nearest well--------------__Distance from foundation,_-----------------.Lining material_---.-.---------..---------_._--__-__. <br /> ❑ Size: Diameter---- - ---------------------- ------Liquid Capacity-_------------------------gals. <br /> -.Depth----- ------------------- -' --- Q <br /> Privy: Distance from El nearest well. <br /> ----------_--------_'--------------- <br /> ----------Dis-tance from nearest building---------------------- <br /> -------------------- <br /> Dis earest lot Ime_- -- - -----Z=----------- ------------- -------------I-------------- - --------------------- --------------------- <br />• A. 4 <br /> Remodeling and/or repairing (describe) ----------------- ----= -: --... - ;� ' <br /> ---------------------- -------------------------------------- -------------•--------- <br /> ----------------- • -- - _------------------------------------ ---------------- <br /> --------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ---------------- <br /> --------- --------------------------------------------------------------------------------- ----- <br /> I hereby certify that l have prepared this application and that the work will begone in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> .- <br /> r -------------------------------- <br /> (Signed) -------- -----(Owner and/or Contractor) <br /> ------------------- -------- <br /> ay:_ ` aCr- -------------------------------------------------------------------------------------(Title)--------- ------------------------ -- ---- ---- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> s <br /> t FOR DEPARTMENT USE ONLY <br /> F APPLICATION ACCEPTED BY_�R ----------------------------------------------------------- DATE - - -- ------ = ---------------------- <br /> REVIEWEDBY--------------------------- ------------ -----------------------------.--•- DATE----------------- ------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------- ---------------------------------------------------------------------------------------- DATE--------------------------_-------- -------------------------- <br /> Altera+ions and/or recommends <br /> lc ----------------------------- <br /> ------------- -------•------ - .. <br /> F' �/J lv S� ��G2.e- -- ---- --- - -- � <br /> ` '----- - --- -------------- - ---- -------- •------- ------------------ <br /> -------- -------------------------------- -------------- ---------------- --------- -------- -------------------- ------------------------------------------------------------- <br /> ----------------------------- -------------- -------------------- - ------------------ -------------------------------------------------------------- - -------- <br /> . f � <br /> I FINAL INSPECTION BY: Date - r..� ._- :5------------------------------ -------------- <br /> '�SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> IN <br /> 1801 E.Hazelton Ave. 300 West Oak Street, 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> �"""� 'Lodi,�California Manteca,California Tracy,California <br /> F.P.CC. i <br />