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APPLICATION FOR SANITATION PERMIT Permit No. ._l_____._7_/, ..... <br /> (Complete in Duplicate) . Date Issued <br /> ✓ Application is hereby made to :the San`JoaqulntiLocall.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. <br /> C , 2q -------------- <br /> JOB ADDRESS AND LOCATION---------- ----------•--•---....----E--=----------------------. <br /> Owner's Name_,l`1� 'I- -•----------------------------------------------- -----------------sPhone----------------------------------- <br /> Address <br /> 521 , -----}- _41----- ----•-•--------------------- ---=------•--------------------••�------ <br /> Contractor's Name------•---•--------- .! ✓-_..k---------;-------- Phone <br /> l <br /> Installation will serve: Residence 0Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ __ Number of bedrooms ___3'Number of baths --. Lot size Af'`7_'_` __. _�_- ___-_t__ <br /> Water.Supply: Public system ❑ .. Community system'❑ Private 0 Depth to Water Table . ft. <br /> Character of soil to a depth'-6f 3_feet:`Sand_[TGra 1 E!'"Sa-nndy-Loam❑"Clsy Loam ❑ Clay ❑ Adobe ©—Hardpan ❑ <br /> Previous Application Made: Yes'❑ No New Construction: Yes ©�o ❑ 1=&/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS`': ; -�-.�„_ <br /> (No septic tank or cesspool permitted if public sewer is available w3hin 200 fe/et.] <br /> Septic Tank: Distance from nearest well__: ._ ---__Qistance from foundation-_/_�___r_-___.MlateriaL_ >_'_C__ ______... <br /> No. of compartments______.___________Size_ _ ._ _______•___Liquid depth---- �______-Capacity-_-__-��-_._____ <br /> Disposal Field: Distance from nearest well---_-`T-----___Distance from foundation__,�n _r____-_Distance to nearest lot linei_�R__�___- <br /> / Number of lines - <br /> __ __ <br /> ____�-- _---'r---_- L-ength-of-each-line-==__ S--: _ <br /> _____ .Width of trench___ �___- <br /> Type of filter material___-`_ d_Pel*-4__=Depth of filter material_-_---.f_ -------Total length-------------------1 `__:_____._____ <br /> r. s d <br /> Seepage Pit: Distance to nearest well__ -----------------Distance om foundation__________________.Distance to nearest lot line____`$_______--. <br /> Number of pits___._I---------------Lining,material.(L _..___De tn �^d <br /> 1 �. 13 / <br /> Size: Diameter P ------------- <br /> Cesspool: <br /> -----Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Linn-ing material------------------------------------- 4 <br /> ElDiameter--------------------------------------Depth----------------:---------------------------- - --Liquid Cspacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------_-------------------------------Distance from nearest building'-.,------------------------------ <br /> _-----__________________ _ <br /> 0 Distance to nearest lot lin e-^ ____________________ _ <br /> f <br /> e <br /> Remodefing and/or repairing (describe)---------------------- ---------------------------------------------­­----------- <br /> --------=------------------------------------•----------------------------------------------------------------- ------ <br /> ------------------------------------------ ---------------•----------------------------•-••------------------------------------------------- ------------- - . ............ - <br /> ---------------------------------------------------------------- ----------------------------------------•------•--...-•----------------------------------------------------------•------.-.-------------------------------- <br /> ------------------------------------------•-------- -----•-----------------------•-•----------------------------------------------------------------.------------- ----••-•---------•- <br /> I hereby certify fhat I have*prepared this application and that the work will be done n�accordance with San Joaquin County <br /> ordinances, S at laws, and rules `end'regulations of the San Joaquin Local Health Districf� { <br /> Si ned (Owner <br /> .; <br /> { 9 } ----- - -{Ownerand/or Confrac+or) <br /> u <br /> y J i" <br /> gY= . .1%Wit__ . ,-. -------------------(Title)4?-�A-_.. s --- ---•------ -- --------------------- <br /> (Plot plan, showing.size of lot, location of s)s+emrelation to wells, buildings, etc., can b�placed on reverse side). - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------- ------ -----------------------------------•----------- ---------------------- DATE---- <br /> .._ <br /> _ _ F I J__________________________________ <br /> REVIEWED BY----------------- ----------------------------------- -----=--------'------.------------- <br /> A <br /> BUILDINGPERMIT ISSUED----------------=--------------------------------------------- -------------------------- DATE---- --'------------------ -------------------- <br /> Alterationsand/or recommendations--------- ----------------------------------- ----------------------------------- -•--------•---------••------•-------------•------- <br /> -- - - --- :- <br /> CV <br /> - <br /> -------------------- - -------------------------------- ------------------•---------------------------------------------------------------•---------------------------------------- <br /> K <br /> FINAL INSPECTION BY: ------- - --•---------------- - Date------- `'�� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street E32 Sycamore Sfreet 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-21x1 , Revisea 1.57 EP.CO. <br />