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_�� _� �a _� <br /> APPL_tc:ATION FOR SANITATION PERM f r Permit No. <br /> ----------------------- - -------- (Complete-in Duplicate) <br /> This Permit Expires 1 Year From Date Issued bats Issued .__ __ _ =- <br /> FAppIric,ti,. 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- 12-/049 Wim, <br /> JOB ADDRESS AND OCATION - - C u-�a� �s.�.o. R --`-'-`- - 'e, <br /> OB �---------------------- <br /> ili Phone <br /> ------------------------------- <br /> Owner's Name..------ ---- -- - ---- � -- -- -------------•---- ------------- -- ---�. <br /> Address---------------- ��J --------- ------- f - <br /> - <br /> Contractor's Name------ -- -- --- -------- --------------- ----------------- - ----- ---- -------------------- Phone <br /> Installation will serve: Residence.�Apartmenf House ❑ Commercial ❑ -Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/`__-Number of bedrooms-�r5_ Number f baths-_!--__ Lot size ----- ___ _.__.__..____ ______________________ <br /> Water Supply: Publics stem Community system'[] Private Depth to Water Table ._____ ff <br /> Y ❑ Y <br /> F <br /> haracter of soil to a depth of 3 feet• Sand ❑ Gravel E] Sandy Loam ElClay Loam Clay E] Adobe F] Hardpanevious 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 /> F.Septic Tank: Distance from nearest well________________Distance from foundation-------------------Material-------------------_ <br /> ❑ No. of compartments Size-------------------- -----------Liquid depth--------- -- ---- -------.Capacity---------------------- Q <br /> FDisp ld: Distance from nearest well.....5o--f.-Distance from foundation_ d----------- <br /> _� Distance to nearest lot line--cY........... <br /> Number of lines.---------/------;------n--------._Length of each line--------/0-C� -------Width of french.-.--2X------------------------- <br /> Type of filter material_____ _`�-----__Depth of filter material__-.�_9_��--.-.Total length-----1.P_P__°__--________________ <br /> Distance to nearest well-- -Q.P-------Distance from foundation__-__ _d ,__.Distance to nearest lot line------ <br /> b + ❑ Number of pits... ..../-----_-----Lining material------ ---- Size: Diaxue#er.4'XJ_A-'--Depth----- <br /> ------------------- ` <br /> Cesspool: Distance from nearest well ________________Distance from foundation.__.__---__.._-_.Lining material--------.-------.--------------------- <br /> 0 <br /> _._ ._ _❑ Size: Diameter- -- --------- ----- ----------------Depth---------------------- ---------------------- -----Liquid Capacity------------------------ -gals. <br /> —Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------.-------. <br /> ❑ Distance to nearest lot line------------------- ------------------K---------------------•---- ---------------------------------------------------------- -- } <br /> FRemodeling and/or repairing (describe):------ t ---------------------------------_------------------ S <br /> r <br /> ------------------------------------- ---------------------------------------------------------------------------------- <br /> ( <br /> F <br /> ---------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------- ------ ---------------------- <br /> -- ----------- ------------------- --- ------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 1 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 /> ---- --------- ------------------------------------------------------ nd or Contractor <br /> [signed)---------- ----------- *'a / ) <br /> By:------------------ _ �r ____----------------_---__----------(Title)___________.____.._._.__.._._.._..-_._...__ <br /> Plot plan, showing size of lot, location of system in relatio to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> kAPPLICATION ACCEPTED BY -------------------------- ---- DATE 'r ---------------------------- <br /> REVIEWED BY.---.-------_----------_----- ------- ------------------------------------------------------------------------------- DATE------------------------------- - <br /> BUILDINGPERMIT ISSUED-------- -- ------------- - ------------------------------------------------------------------- DATE------------------------------ ------ - - --- -------------- <br /> Alterations and/or recommendations:---------------- ----- ------ -- - ------------------------------------------------------------------------------------------------•------------------- <br /> - ------------------- <br /> - ------- -- ----------- ---------------------------------- ------------------------------------------------- -- --- <br /> F] -- ---------- - -------------------- --- - - - -----------------------------•------------------- -------------------------------- -- <br /> ----------------------- - <br /> ,�p <br /> FINAL INSPECTION BY -.- . -- -- ----- Date__-�f--r_�_-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slockton,California Lodi, Colifornia Manleca,California Tracy,California <br /> F E.H.9 2M 1-67 Vangvord press <br />