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FOR OFFIC S <br /> ---------------- --------- APPLICATION__.._. APPLICATION FOR SANITATION PERMIT Permit No. ._ ..-. . <br /> ------ ------------------- --_------------ ------------- -- (Complete in Duplicate) <br /> e_�_ -_ -- This permit Expires 1 Year From Date Issued Date issued ____________ <br /> ------- ----- ----- -- ---------- <br /> -- 2-03— 0245--�3 <br /> Application is hereby made to the San Joaquin Local Health- District for a permit to construct and install the work herein described. I <br /> This application is made in compliance with County Ordinance No. 549. I s. --o. p..r <br /> JOB ADDRESS AND LOCATION 1� --------- / --------------------------------------------------------------------------------------- <br /> Owner's Name----- <br /> a <br /> -- --------------------------------------- Phone=------ �. <br /> Address----------------•....................... <br /> •---....--------------------------•----_::.-------------•----•--•---•--------•-----..._..----------------------•----------------------------•------------------•----- <br /> Contraetor's Name.. -_..p r 'e!' f! �T' C /Y�--------------•------- ---•-------•-----------•--...--- PhoneA<�e?&<-e°��------ <br /> Installation will serve: vResidence WApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> l � � <br /> 'Number of living units: .1--- Number of bedroomst _r____ Number of baths __/._ Lot size .-•--.dlk�,-0---- ---------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table t _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date--------------------) No Q *"New Construction: Yes ❑ No f'''FHA/VA:Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: A <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' <br /> Septic Taq Distance from nearest well---------._'__'-Distance from foundation-------------------Material_.___.________.-_____._..........._____________-. <br /> ❑ No. of compartments--------------------------Size-------------------------------Liquid depth-------------- - ---- <br /> --_Capacity---------------•------- <br /> Disposal Fi Distance from nearest well.-. Distance from foundation_ _____YZ9______Distance to nearest lot line_____..... ! <br /> ______________Length of each line_______ <br /> Number of lines..._.-•--_-.-�- -- g C Wid#h of french------ <br /> �x Type of filter material. ae°/�._.__--.-Depth of filter material-. �:i�----Total length........._�Q!_______________ <br /> Seepage Pit Distance to nearest well---/_'______Distance from foundation...../. .__.Distance to nearest lot line.... ` <br /> ® �d, Number of pits-------/-----------Lining mate -----Size: Diameter------- ."____,Depth--------- Vit...:............ <br /> Cesspool: Distance from nearest well.................Distance from foundation---.----------------Lining material---------------------- <br /> ------ <br /> ❑ Size: Diameter------------ ------Depth------------------------------•-------------------•-Liquid Capacity -----_---------- <br /> Privy: Distance from nearest well------------------------------------------.------Distance from nearest building_.___.___...-.._._...--.-•---------•__--` <br /> ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------- <br /> Remodeling <br /> -------------------------•-•-•-----•--••--------'Remodeling and/or repairing (describe):------..,-V�547-----TT-P----- '1.. %! -----3"f_-'-r: ---------------------•-- <br /> --------------•----•-----------------------------------------•i --- <br /> ----------•--••----•-•--- •--------------------------•--- ---------••------------------------------------------•-•--------------------------------------------------•-----------....----------------------------------- <br /> • ,I <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. 7 <br /> (Signed)------------ ,_- :- ----ter e�s G, (Owner and/or Contractor) R <br /> By:-------------- ---- - --- (Title --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ! <br /> I <br /> t -g <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_._.- '� - ----•------ ------------- ------ ----- DATE--------1------------------------- <br /> REVIEWED <br /> -------------- -------REVIEWED BY------------------------ •------------ '--;-------- - -- ------------------------------------------------------- DATE-----------------------------------...._.------------------- a <br /> BUILDING PERMIT ISSUED--------------_--------------- --- — -----------••------------------------ DATE------------------------------------------------- <br /> Alterations and/or recommendations:;---------- ------------------------------------------------------------------------------------•---•---•---------•---•--------------•-----------------••---- <br /> ---- -- ---------­---------- -------•--- = _.._...--•-- <br /> �_ G <br /> - --------•--------------- ------- <br /> ------------------------------------------------------•---------------------------------------------- <br /> FINAL INSPECTION BY: Date 5 -.' rr <br /> A' <br /> INJOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISEd 8.59 21A 5.62 ATLAS <br />