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APPLICATION FOR SANITATION PERMIT Permit No. ____ _L--_------'--- <br /> (Complete in Duplicate) <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local 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 /> JOB ADDRESS AND LOCe.ATION� �- ,F �'�^---- <br /> Owner's Name__1 ,/ °- '�- ----- - ---LIZ--------------------------------- ------------------------------ ---- ------- Phone--------------------•--------------- <br /> Address-------•-- --------------------4.4124 <br /> a/ <br /> Contractor's Name__ ----_.-- -- --�4- -- ---- -- ---- Phone---- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I------ Number of bedrooms __J___ Number of baths Z __ Lot size __3--- _____'____-_______________________ <br /> Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table 34- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,] Clay Loam ❑ Clay ❑ Adobe [) Hardpan ❑ <br /> Previous Application Made: Yes ❑ No.X New Construction: Yeses No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: _ - � <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest w Il_,c? -'__ Distance from foundation-IR-*-`_______.Material___�''" ______________________. <br /> ,® No. of compartments-------------- -----------Size-A_"s4-_/--_-- 14_Liquid depth-----f�-Q---------------Cap acity-� -�"1D------- 4 <br /> Disposal Field: Distance from nearest well...I�----Distance from foundation_pt_.d_0-------Distance to nearest lot line__ <br /> 0] Number of lines _ _.#.�z -Length of each line.P._`Q° _.Width oftrench_._�__'-------------------- <br /> s <br /> Type of filter material-�_f7�Depth of filter material__At'!------------Total length__ —Vo_____________________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation---.............._..Distance to nearest lot line--._-.___________ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------.-------Dept h--------------------------------- <br /> Cesspo& Distance -From nearest well-----------------Distance from foundation--------------------Lining material__-__-----__----___._______________ <br /> ❑ Size: Diameter--------------------- -------- ------Depth--------------------------------------------- ------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--__________________________-_________._. <br /> ❑ Distance to nearest lot line----- ---------------------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------- <br /> -------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- Vi <br /> ----------------------------------------------------------------------•------------------------------------•---------------------------------..----------- ------------------------•-•------------------------------------- Q <br /> -------------------------------------------------------------------------------------------------------------------------------- ------ r <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. <br /> (Signed)------ -G4-'�------- ?------- and/or Contractor) <br /> By:- I. _ _ (Title) _7, - - <br /> 1 <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY �. <br /> APPLICATION ACCEPTED _ ------------------------------------------------------------ DATE--- <br /> m.a <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------- --------- DATE <br /> BUILDING PERMIT ISSUED------------------------- ------ ----------------------•---•---------------------------------------- DATE <br /> Alterationsand/or recommendations:------------------------------------------------------------------------------•--- ---------••---------------------•--•-------------------------------------- <br /> ­--------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------- ------------------------------------------•-------•--------•----------------------------------------------------------------------- <br /> ------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- <br /> FINAL INSPECTION BY:..__ _ _ <br /> / - --- ---------------------- Date /- - -------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stock+on, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M . Revisea 1.57 F.P.0O3 <br />