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FOROFFICE USE. <br /> -------------------------------------------------------- <br /> ------- ------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------------------ - (Complete in Duplicate) <br /> ------------ ----------------------------------- -------- This Per- mit'Expires'l Year From Date Issued Date-Issued --- <br /> rei�n <br /> 4 ed. <br /> Work IF, eos—c,, <br /> Application is hereby made to the San-Joaquin Local Health District for a permit to construct and install the Wo <br /> This application is made in compli ce _Joaquin <br /> County Ordinance No. 549. <br /> AND-LO JOB X-D-D'RES-2S AKN-'D"-'L'O ipoi, <br /> Owner's Name__- ------ Phone <br /> ---- - - ---- - -------- --------- ------------------------------ <br /> ............... ......... <br /> Address1� / <br /> ...... <br /> -------------- ............ <br /> Contractor's Name_____f------- <br /> 7 ---------------- Phone. ..................... <br /> Installation will serve: Residence ❑ ' Apartment House E] Commercial Trailer Court [j Motel E] Other E] <br /> Number of living units: Nu6iber of bedroom's Number of baths --"/- Lot size <br /> --------------------------- <br /> ommunify-system E] Private 1-1 -Depth to Water Table ft, <br /> Water Supply: Public system EKC ,W- - ," - <br /> Character of soil to a depth of 3 felt: 'Sand E] Gravel E] Sandy Loam Clay Loam.E] Clay [3 <br /> I ! z - Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date--------------------) No 22� New Construction: Yes k9-1To [] FHA/VA, Yes [I No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool ' m <br /> f . 1�er iff <br /> ed-if,public sewer is available within 200 feet.) <br /> Septic TgjiL- Distance from nearest st well------—-------D from founclat o <br /> ea n---/10-------Material---- <br /> Nc�; of cbmpar4en'fs------ ---------Si 4�a__Liquid clep�h__'_X__' /---------Cap it --- -------- <br /> --- • <br /> - ac y- <br /> Dispos:a!l lcl: Distance from nqares -------- 7 <br /> t well-----'_-Distance from fo'undafion--- --_Distance to nearest lot line.0-------/ <br /> Number of <br /> --------------/Length of each line__:Z <br /> i. <br /> � 64�7------------------.Width of trench- ------------------ <br /> -Tye of filter material- ___Depth of filter material---IY� Total length-----/26:e <br /> ----------------------- <br /> Seepage Pit: Distance to nearest,weII_-____,----------------Distance from foundation---------------------Distance"to nearest lot line______________ <br /> r! Number of p;fs-----------------------Lining material-----------------------Size: Diameter-------------- -- -----.Depth----- -----------------------11 <br /> Cesspool: Distance from nearest well-----------------Distance from-foundat.ion--------------------Lining material_______- <br /> El Size: Diameter f ei, : - <br /> -----------------------------Depth----------------------------------------------------Liquid Capacity- .---------- ---- <br /> ---------------gals. <br /> Privy:' Distance from nearest:well----------------------------------------------,-_---Distance' from nearest building__---------------------------------------- <br /> ❑ Disf�nc'e_ib' nearest lot I;ne--* -------------------------------------------- - ----------- <br /> Ah <br /> Remodeling and/ 6, firing -e 7 <br /> ----------- 44L I <br /> ----------:------------------ -------------------------1� <br /> --------------;�Z � 4 A e� .......... <br /> e -------- ------------------------------------------------------------------- --------- <br /> .. .......... <br /> ------------- --------- <br /> -------------------------I-------- -----#-- <br /> ______ __________________ <br /> .......... ------------------------------------------------------------------7-----------------------------------*-----------------------------------------*--------------------------------- <br /> ---------------------------------------------------------------------------- ---------------------------------------------- -- ------------------------ <br /> --------------- --. __--- ------ - --------- <br /> I hereby certify that I have preplared-this'ap�Wic�sfion and that the work"will be done in accordance with San -Joaquin- - ­C.ou-nty <br /> ordinances, State laws,' and rules and regulations otthe San Joaquin Local Health District. <br /> --------- -------- <br /> (Signed) <br /> --- - -- -- --------------- -- ------------ --- --- - ---- ------------------------------------------------40wffisz!j� Contractor) <br /> ----------------------------- 4 ! <br /> By: - _ & - <br /> ------------------------------------------ ---- -------------ffitle)_ �, , I <br /> ------------------- <br /> (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can-be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED-BY-f--,--"2.,r4,--.--- ------------------------------------- DATE----/------- <br /> - --------- ----------------- <br /> REVIEWED BY------------- <br /> ------------------------------------- DATE- <br /> BUILDING <br /> ATEBUILDING PERMIT ISSUED------------- --------- ------------------------------------------------------- DATE----------------------- -------- <br /> Agie ---------------- <br /> - ---------------- -----------......5 <br /> '56tions and/or recommendafions._�-._'_, ell,- ------ <br /> ----------- ------- <br /> --- -------- <br /> Z�- -------- er <br /> ---- -- -- -------- - -- ---- ------- 0�t—------------- <br /> ----- -------- <br /> ------------------------ ----------------------------- ---------- -------------- -------------- <br /> ------------------------------------------------------------------------------------------- ------------------------------ <br /> 0) <br /> FINAL INSPECTION BY:------ ----------------------------------- Date-- �� <br /> SAN <br /> ate--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American street <br /> 300-Wes!Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California <br /> Lodi,California Manteca,cald*\ka 13 <br /> Tracy,Caiiforriia <br /> EE-9 RrylrED S-SS r.P.CO.2M 6-60 <br />