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----- --------- -- -- ---------- <br /> ----------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------------------------- --------- ------ .....1� '- <br /> -------------- ---- (Complete in Duplicate)T hnis Permit it fres From Date Issued <br /> es , Yearm Date Issued <br /> A <br /> T� cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> P" <br /> is application is made in Compliance with County Ordinance No. 549. described. <br /> JOB ADDRESS AND LOCATION.._.__.. .1 7_1 <br /> Owner's Name__. --------*------------------- <br /> Address_ ..............CZ ----------- ------- ------------------------------- r------*W�7- <br /> ------------..............................5--------- no.. .................... <br /> Contractor's Name----- ------- -----------f­_f <br /> Installation will serve: ------------------- --- ------------------ --- . ...... Phone.......... <br /> Residence Apartment House ❑ Commercial Ej Trail Cou ......................... <br /> Number of living units: --- Number ❑of bedrooms OtOl 0 Other 0 <br /> Water Supply: public system E] Community system <br /> :!=Number of baths ..-,e (AS <br /> --- Lot size ....2 <br /> I . _ .............. <br /> Character of soil to a depth of 3 fee tem 0 Private Depth To Water Table.-_7_.V:­ft. <br /> +: Sand GravelF] Sandy Loam E] Ga Loam' <br /> Previous Application Made: (If yes,date_____________"_."__) OmE3---ClayD Adobe[] Hardpano <br /> NoLl—NewConstrucNon: Yes [] NoL2--4HA/VA: YesF <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: -1 No H_ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest from foundation-----el.s-A <br /> No. of compartments---------Z_-------Size------- Materia.___- ------------------------------------- <br /> Disposal Field: <br /> -liquid depjh--- -----------Capacity.........:2 ... <br /> Distance from nearest well_--_ _7_5�a Distance from founclafion_­-Y_5-�....Distance to nearest lot line <br /> Number of lines / <br /> ----------------Length of each line <br /> Type of filter material, _0�_Width of trench__.._.___._ Z_ <br /> Depth of filter -----------Total 14ngth. ------------------------------- <br /> Seepage Pit: Distance to nearest well ............ ------------- <br /> I <br /> Number of pits------- _5?� _ Distance fr5m foundation-..--e'.��.e..Distancd to nearest lot line____..-Z; -- 1� <br /> Cesspool: -------Lining material.____ �_Size: Dept .......... <br /> ------------ ............ <br /> Distance from nearest well_______-_____._ Distance from foundation.__._._"______ ON, <br /> -------- ini <br /> ❑ Size: Diameter______"-"_"""_______ -----------Dept h--------------------- L ng material------------ -------....... ........ <br /> Privy: Distance from nearest well_--"-"_--"_____-__-- -----------------------Li quid Capacify-------_------------_-----gals. <br /> El Distance to nearest lot line---------------- - ------------ ---- --"_-_Distance from nearest build I Ing•-------•----------__-•- <br /> Remod <br /> ------------------------Remodinq and/or repa i .�ng (describe); ------------------------------------------------------------------------------------------ <br /> ---- <br /> - ------------- --------- ------- -------�Zp <br /> --------- <br /> -- -------- <br /> ----------- <br /> ----------- <br /> ------------- -------------- <br /> the vo�r�w,I I 'b <br /> ---- ---- ----- --- - ------ <br /> -----:15hereby certify that I have prepared this applicafloo-a"nd e done in accordance 1with----Sen <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Sign <br /> ------- ------ ---- <br /> BY:................................. --------------------- ------- ----------------------------------(Owner and/or Contractor) <br /> ------------------------------- ------------------------------------------------- -----------------(Tifie)_---------------------- ------ ------- --------------- --- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> F-WEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> B ' BY-_ <br /> ----------..-.-.-.-.--- ----- -- t--- ----- --------- DATE..REVIEWED BY-.- - --- <br /> ------- <br /> .i..-. <br /> ---- DATE <br /> - <br /> .............. .... ....UILDING PERMIT ISSUED----------- ----- ............... <br /> ..................... .- -------------- DATE---------------------------------------I ----------- <br /> -- <br /> Alteratio sand/or recomm?endations:--'I------------------- -- ------ -- ---------­------------------------------------- ------------------ <br /> ............ <br /> ----ft---------------------------------------*--------*-----------•- --- ------ - <br /> -- <br /> ------------------------------------------------------ --------- ----------------------- <br /> ----------------------------------I------------------ ------------------ ------- <br /> ------------------------------------------- -------------------------------- ------ ------------------- ------------------- ------- ------------------------------------------------------------------------------------ <br /> ------------------------_---------------- ...... <br /> FINAL INSPECTION BY: <br /> /Z �i�----------------I——---------- -------------- ------------------------------------------- <br /> -------------------­ <br /> _ Date--------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street <br /> Stockton,California Lodi,California 20S West 91h Street <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br /> Manteca,California Tracy,California <br />