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11 APPLICATION FOR SANITATION PERMIT Permit No. .--?L/---s1..... <br /> i (Complete in Duplicate) Date Issued Nt _1y_-___ <br /> de to the San Joaquin Local Health District' for a permit to construct and install the work herein described. <br /> Application is hereby ma q <br /> This application is made in compliance with County Ordinance 549. <br /> /J Ga <br /> JOB ADDRESS AND TION ----------------------------------------- - r <br /> Phon -- ---- .SGS <br /> Owner's Name- <br /> 04�` - ----- <br /> "` -- <br /> ' --------- ----- -•-- Phone---- 12- � <br /> Contractor's Name------------------•----•�` �---- -�--�.1� ---��------ .r <br /> Installation wil' serve: Residence�� Apartment House ! ❑Commercial Trailer Court ❑ Mote E] tth er <br /> 4 f `*e / <br /> Number of living units: /-____ Number of bedrooms -------- Number of baths ___ -__ Lot size ___�__-_ --___.-_____ <br /> r <br /> I N ; I tN I • <br /> Water Supply: Public .system Community system El Private E] Depth fo Water Table'Vs ft. <br /> r � r <br /> Character of soil to a depth of 3 feet: Sand ❑- Gravel [ISandy Loam ❑' Clay Loam El Clay ❑ Adobe Hardpan E] <br /> F <br /> Previous Application Made': Yes El 'No � New Construction: Yes E] N0 <br /> FHA/VA: Yes ❑ No El <br /> TYPE OF INSTALLATION 'AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> pt'c Tank: Distance from nearest well-------;'------Distance from foundation--------------------Mater'sal---------------------------------- <br /> No. of compartments----------------i---------Size------ ------------------------Liquid depth-!------------------------Capacity---------------------- <br /> I Distance from-foundation___._____:__-____IDistance to nearest lot line----------------- <br /> �p ,ield:"�""'Distance'from nearest well-.___ ______ - <br /> Number of lines--------------------- --------Length of each line-----------------------------Width of french----------------------------------- <br /> Type of filter material_____________k_,____--___Depth of filter material ----------------------Total length------------------------------------------ <br /> See <br /> __--______________--_______--______`_._Seepage Pt: Distance to nearest 41l *AA --Distan m f ndation__2$7Zj______-Distance to nearest lot line/ <br /> Number of pits-------- ----"------Li ling ti <br /> ng Dia ----------Dept -------------- <br /> Cesspool: 1Distance from nearest well_-______________Distance from foundation_________ ___ Lining material-------- --------------------------- <br /> ❑ Size: Diameter----------------------------- ------Depth----------------------------------------- = Liquid Capacity gals. <br /> Privy: Distnnce from nearest well-------I-----------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line--------------------------------------------------- ------•------------------------------------------------------------------------ <br /> � 1 <br /> Remodeling and/or repairing (clescribe)----------------- ---•--------Z----•---------..--------------------------------------------------•-------------- <br /> l------ <br /> ------------- ------ --------------------- <br /> i ---------------------- ----•----------- ----------------- <br /> ----------- -- <br /> s <br /> ------- - ----- <br /> ! 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 'Joaquin Local Health District. <br /> )-- - ; �G l''u _V,--- ------------ -------------------- <br /> (Sign (Owner and/or Contractor} <br /> ed . gelo <br /> * Title , - . <br /> Ve <br /> (Plot plan, showing size of lot, location of system in' relation to wells,'6uiildings, etc., can be placed on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> 1 14 -.- DATEW.-------------------- - <br /> r --------------------------- - <br /> REVIEWED BY----------------------•-. J­71 - DATE <br /> BUILDING PERMIT ISSUED----------------------------------- - ---------------- DATE --- -------------------------------------- <br /> Alterations and/or recommendations-------------------------------------------------------"----------------•-----------------------•------------•--•-------------"•------------------------- <br /> -----------I----------------- <br /> --------------------------•------------------------------ -------------------------- <br /> 3 - i . t, --------------------------•------------------------------------- <br /> ; . <br /> ------------------------- -- <br /> FINAL INSPECTION BY:. Date---- 3-------- --- ------------ ------------------------- <br /> SAN JOAQUIN LOCAL Tracy,HEALTH DISTRICT <br /> 300 West Oak Street f 132 Sycamore Street 814 Nor+h "C" Street <br /> 130 South American Street <br /> Stockton, California Lodi, California ,. `/ Manteca, California ` <br /> ES-4-2M Revised 1.57 F.P.Co- <br />