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4 <br /> PLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) 7/G S <br /> 0 Date Issued <br /> TApplicatia is hereby made to the Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This appGca -ori is made in co lance with County Ordinance No. P49. <br /> a <br /> JOB ADDRESS AND LOCATION------- {`A=�-------- <br /> Owner's Name `' ra �- ---- ----- <br /> Phone. <br /> Address--------------------- r <br /> ----------------------------- -----------------------------------------------------•--------------------------------------- <br /> Contractor's Name_,,.—` " �� '.... -7 --------------------------_-- <br /> Installation will serve: Residence,7�—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> < �_, r <br /> Number of living units:__ Number of bedrooms_. Number of baths. -- Lot size _- <br /> Water Supply: Public systemommunity system "Private ❑ " Depth to Water able {�� <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay E] Adobe Hardpan El \P <br /> Previous Application Made: Yes E] Now Construction: Yes I-] No FHA/VA: Yes ❑ No ❑ f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1t <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> tic - 'Distance from:nearest well-----------------Distance from foundation--------------------Materia4----------_--.------.-------------.------___----. <br /> -'� No. ofCompalrtmen#s--------------------------Size--------------------- Liquid depth___----____ -------------CapacitY---------------------------. = <br /> �sp ielcl: Distance from nearest well__-�6 _-Distance from foundation-- --------------Distance to nearest lot line---- -...... <br /> Length of each line- --- -._"__---_ Width of trench-__--s '�----------_._ <br /> "� Number of lines-------- ------�--- f! . <br /> Type of filter-material- Depth of filter material------- length---------------- - ------------------ <br /> Seepage Pif: Distance to nearest well-._V?!c _-__Distance from foundation----_Z�-`--___.Distance to nearest lot line_.--_14� <br /> Number of pits____j----------------Lining material_- F <br /> Si,,: Diameter------- _-�--Depth____.;_a�_--_---____ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------.---------Lining material------------------------------------- <br /> Size: <br /> _____.__-- ___-_______--_____--_-__Size: Diameter------------------------- ------Depth---t------------------------- ------------- --------Liquid Capacity-.-------------------- -----gals. <br /> Privy: Distance from nearest well-----------------------------------.-------------Distance from nearest building------------------------------------------- <br /> Distance <br /> __--____---_-_----__-___._,_- ----_. <br /> ❑ Distance to nearest lot line-----`-------------------------------------------------------------- -----------------•---------•---------- --------------------------- <br /> Remodeling and/or repairing (descri - -------- <br /> -------- - - ------ <br /> ------------------------------------------------------------------- ------ --- ----------------------------1�-------------------=-------------- <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 /> ordinancii� tate laws, and rules and regul tions of the San Joaquin Local Health District. <br /> r <br /> (Signed._ ---- ----- k ' r ---- ----��'-�—'-- ontractork <br /> BY: " (Title)------------------- ----------------------------------------- <br /> ---------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in.relati IIs, buildin , etc., can be placed on reverse side). <br /> FOR' PARTMENT USE ONLY T <br /> APPLICATION ACCEPTED BY-------•----:j DATE �r <br /> REVIEWEDBY---------------------------- -------------------------------------------------------- ----------------•-•------------------ DATE---------------------------- <br /> BUILDINGPERMIT ISSUED------_------- -------------------------------------------------------------------- -•- -- DATE------ •---- <br /> Alterations and/or recommendations:-------------- --------------- -----------------------•------------------------------------------- ----------------------------•------------------------- <br /> -•-- - c - ----- ---•------------------------------------------------------•--------- ------------------ ---- <br /> - <br /> - --------------- -- <br /> _ e '' r ----- - <br /> ' ----------- ---- -----------� ­ � - ' ------ --- -'��- �--- ---- ----------------``---------------- <br /> ��i Date --------- <br /> FINAL INSPECTION BY:--Il��- ,- -- -- --- _ `� 1 <br /> >� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-4-2M Revises 1-57 F.P.Co. <br />