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Arr'LICATION FOR SANITATION PERnnl7 Permit No. <br /> t ' (Complete in Duplicate) f <br /> �i �.. <br /> Date Issued <br /> 1 - , <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 applicafion is made in compliance with County Ordinance No. 549. <br /> ----------------------------------------- <br /> JOB ADDRESS AND <br /> t 1 Owner's ame----- -------------- - Phone <br /> --------_ K:• <br /> A <br /> Fi Contractor's Name--- 1Y-` -- - - .7-HT--- -- ,----- 1CC'a--------------- ---------------------------------------•--: Phon /(J__ �QI _ <br /> e. <br /> Installation will serve: Residence ❑ Apartment House [] Commercia --`Trailer Court ❑ Mojpl ❑ Other ❑ <br /> �i Number of living units: -------- Number of bedrooms -------- Number of aths -----.-- Lot size _____________________________ <br /> i Water Supply: Public system ❑ Comm nity system ❑ Private Depth to Water Table �� ft. <br /> Character of soil to a depth of 3 fee . Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--Heirdpan [] <br /> F Previous Application Made: Yes 91 No ❑ New Construction: Yes ❑ No - FNA/VA: Yes ❑ No j <br /> � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or'cesspool permitted if public sewer is available within 200 fee+.) <br /> r eptic Tank: Distance from nearest weEl---_-------------Distance from foundation--------.-----------Material-------------------------------_______________- <br /> No. of compartments----------------------- Size______________------------------Liquid de th--------------------------Caacit <br /> osal - d: Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line______.-._______- <br />' Number of lines-----------------------------------Length of each line-----.--------.---------------Width of trench----------_------------------------ <br /> U Type of filter material_______________ _________Depth of filter material---------------------_Total length--------------.--------------------------- <br /> Se <br /> - ________-_____________Seepa e Pit: Distance to nearest well_ _______Distance ro foundation_al, _ ----_.Di tante to nearest lot line.___'# ______ <br /> Number of pits---12____________Lining material-�______._.Size: ,Diameter._._�5�-f*'__---Qepth_.,eZ-S-_.-_.________----- <br /> Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material--------------------------------___.,_. Q <br /> ❑ Size: Diameter------------------------------------ -Depth---------------------------------------------------Liquid Capacity------------------------- --gals. <br /> ' Privy: Distance from nearest wel!________________ ----------_-------------------__Distance from nearest Abbuilding ________ _______----------------- <br /> m <br /> .____---------. 1� <br /> ❑ Distance to nearest lot line----------- ------------- - --------- ------------------- --------------- ------ ------ `\ <br /> Remodeling and/or repairing describe2f 41� <br /> P g )= / tin. ----------------------------------------------------------------------------------------- ------- ------------------------------- ---------------------- <br /> ----------------­-------------------------------- <br /> ------------------------ ----•---------------------------------- <br /> -------------- - -----------------------------------------------------------------------------------------------------------------------------------------------------------:--------------------------------------­ <br /> ------------------------------------------------------------^"-------------------------------------------------------------------------------------- <br /> I 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 /> [Signed]- -i-� -1_ [(r" irt ----- *4 -�{srxk--- ---------------------- ) <br /> ----- Contractor) <br /> By:------------------------- -----..-..--------------------------------------------------------- ---(Title)----------------------- <br /> ---------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to w buildings, can be placed on reverse side). 1 <br /> !1 ] FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_.__ 1 DATE.____.,r3-_'__fl} "- <br /> f_,.- <br /> Eli ----------------- --------------------- ----- --REVIEWED BY-------------=-------------- _ DATE----- -----------------------------•---------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------- --------------------------------------------------------- DATE------ --------- <br /> Alterations and/or recommendations__________________ ___-__. _._________________ ' <br /> I - -------- 1.i _ - .`T (C�l ----- l 't"�`�`� - --- -------�-��------------- <br /> -, - _ ... <br /> ---------------- - - <br /> t - i� <br /> --------------------------------•----------- --•------------------------------------------------- <br /> ________ ----------- <br /> .__-________.._______ __________....___________._._______.___.__._____._____.__________________ <br /> _________ _____ _...____._i----- <br /> _____ 6_._..__. <br /> _ <br /> F1 <br /> FINAL INSPECt-1Ql�fBY:-_- --------- - - - --- ,/;- _ -+ Date---------- --- - <br /> �;�,V, <br /> FSAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132,Sycamore Street 814 North "C" Street <br /> �j Stockton, California Lod;, California Manteca, California Tracy, California <br /> JI ES-9-2M , Revised 1.57 F.P.CO. <br />