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rUK Ut-H(-t USE; <br /> ...................:---------1.............. <br /> ----------- ............. ...... .......... <br /> i�.... APPLICATION FOR SANITATION PERMIT Permit No. <br /> .................... .......z..........__....... <br /> (Complete in Duplicate) //f /� <br /> ................­_­.............. .. ...... .......... Date Issued ----- <br /> - .This Permit Expires 1 Year From Date Issued 1 <br /> Application is her ZI 2- - ( qjV 30&by macle�,fci fhe'San Joaquin Local Health District for a permit to construct and install the work herein descried. <br /> This application is made in 6ompliance with County Ordinance No. 549. <br /> JOB ADDRESS AND L ....A4.49----------------- <br /> Owner's Name................ <br /> -----------......... ....... .............. <br /> Address zw;i <br /> .................. .... . .... .... .... ................... <br /> ----- <br /> Contractor's Name.-_.... ... ... ............ <br /> ---------.......... ... ................ ...... ......------ one............7.77, <br /> n ............... <br /> Installation will serve: Residence D( Apartment House ❑0 Commercial I-] Trailer Court 0 Motel [I Other <br /> ❑ <br /> Number of living uni4: J... Number'of bedroom's Number of baths ........ Lotsize ------ <br /> 41, ---------*-----*------- ---------------- <br /> Water Supply: Public system El Community system F1 Private'o Depth to Water Table <br /> ft. <br /> Character of soil to a depfh.'Pf 3 feet: Sand [:] Gravel M Sandy Loam E] Clay Loar� 0 Clay El Adobe Hardpan E] <br /> Previous Application Made: i�(If yes,date ...........I No Now Construction: Yes No L] FHA/VA. Yes E] N <br /> OX <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200.feet.) <br /> Septic Tank: Disfance',from nearest well....90.......Distance from f6undafion..._1 jl�- &--vo-e- <br /> 0 ........ <br /> No. of c mpartmen'ts........7��.............Size._._3AfTK.6 ---Liquid depth.---67.�y........m Cap;cilv <br /> Disposal Field. Distance from nearest well-4i q.......Distance from foundation...?el(._.__._..Distance __--------------...... <br /> ........Distan to nearest lot line-_`--�_--_• t+ <br /> umber of lines._.___.......3............. Length of each line. Width of trench_...P% <br /> Type of filter ma "11:� ----------- ......... <br /> material. ---------L Depth of filter.material-./;?!".­_..­_Tofal length....P.Z. . ........................ <br /> Seepage Pit: Distance to nearest well......................Distance from foundation............. Distance to nearest lot line._......_........ <br /> ❑ Number of pits..-_._.'... Lining material_.. ... ---....Size: Diameter------------ ----------.Dept h.................... <br /> Cesspool: Distance from nearest well.................Distance from foundaf;on....................Lining material........__._.......-.__-._ <br /> ............ <br /> ❑ Size: Ma4leter • <br /> ................ ..........I Depth........_........_:------------7------------------ Liquid Capacity.......... <br /> * ' L_ � MIt - . ­* - - ! 10� .................gals. <br /> 1rivy: i�,_ Ir o—m - _-�' -''=' - ;. - ­'�­Disfan from n'' <br /> Di, nce1 neariisf,welff................................. ............ ce eirWit 6uildi�'6... ... <br /> ElDistance to nearest,lot line............................................................. : <br /> --------------------------------------------**---------------------- <br /> Remodeling and/or repairing;j(describe):......._­............... ................... ........ <br /> .11;. -------*-----------*... ............�!................................. <br /> --­-------­--­----­..............................................................................I............. r <br /> ............ ........... ........................... <br /> .................... ............................ ........................................... <br /> ................................................................................................. <br /> ordinances, State I <br /> ......................................................................................_..-......_..._..-.-•-----•-•--•--.. .............. <br /> I hereby certify that I h�',ie • <br /> prepared this application and that the work will be done in accordance with San Joaquin County <br /> s, and rules and r gFiations of the San Joaquin Local Health District. <br /> (Signed).. <br /> .............. ....... ................_............... .................................................. <br /> -------(Owner and/or Contractor) <br /> By;....................... ---------- itle) <br /> -------------------- ---- .........................................jTi ........................................ ............ . <br /> (Plot plan, showing size of lot, of system in relation to wells, buildings, etc., can be placed on reverse side).. <br /> IN FOR DEPARTMENT USE ON_LY_ <br /> APPLICATION ACCEPTED BY----•------•----------._. ............................. ------------------------------------------_.- DATE.-----•- <br /> REVIEWEDBY--- --------- ................... .......................... <br /> BUILDING PERMIT ISS-------------- .................................. DATE----- -----------------­--- <br /> UED.............................. ----------------------DATE.......... ............. <br /> Alterations and/or recommen6flons,........ ...... ........----­--------------------------------- ........... .................. <br /> 1. ................................................................................................................................I........... <br /> .---------•..-----........-•-•------•--•..­.­.......-....................................---•••-............----••--•-. I......................­_...................­­.................................... <br /> ................••-•-...........--...__... -- <br /> .....-•-•-•-••------_. <br /> -.................................... .--••-•----....... <br /> -•--- .......................................................................... ........­.­...........................­......................... <br /> .................................­................. <br /> FINALINSPECTION BY111_�.-_.. ...................................................................................................­­.............. <br /> :----_If. <br /> . . ................. Date-------- <br /> 11 ............_.........-•-------.._.....__. <br /> 11 SAN JOA9UIN LOCAL HEALTH DISTRICT <br /> 1601 E.Noxellan Ave. 300 West Oak Sir&*# -124 Sycamore Street 205 Wo6i 9th Street <br /> Stockton,California Lodi,California Manteca,caliForrila Tracy,California <br /> Es 9 REVISED a-59 3M 3-162 F.P.12,13. <br />