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-Ft5R`0>'1~iCE USE: <br /> i <br /> ---------------------------------------.----------------- APPLICATION FOR SANITATION PERMIT Permit No. .__1 - <br /> :: .- (Complete in Duplicate) I <br /> t-(. .� `.: - This Permit Ex ires 1 Year From Date Issued 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 /> �iPa i <br /> JOB ADDRESS AND LOCATION...-J i; + _LIA------- ---Nt' .----- ....... ---- _ - r_ -----T � <br /> Owner's Name aLJ _ F_.---•---------------------------- - --- -- ---------------------------------- Phone------------------------------------ <br /> Address �'' a x L ��1 k- f _ r ------------------------------------I-------­----­­-------- <br /> Contractor's <br /> ---•--..._.._... -------- <br /> V V -- -•- <br /> Contractor s Name _W!AS r _-..._.. i ------------------------------------------------------�--------- Phone <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer emotel ❑ Other ❑ <br /> Number of living.units: _�.____ Number of,bedrooms __umber of baths _______ Lot, size __.__ IX — <br /> Water Supply: Public ;ysfem�❑WCommunity. system ❑ Private E' Depth to Water Tabled ft. r` <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ k Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan E`�' i <br /> Previous Application Made: (If yes,date.__.._..__,__._.._I No J21' New Construction: Yes �o ❑ FHA/VA: Yes ❑ No4�3- <br /> = TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank-or,cesspool permitted if public sewer is available within 200 feet.) <br /> Septi_'cT k: Distance from nearest well___,,5 ._._Distance from foundation__._._.__.-------Material_ __COAbLIR_F_r�__.-____. <br /> No.0 compartments------. -------------5ize_ _x. _�------Liquid depth------ <br /> Capacity----- <br /> Q-C --_-_ <br /> Disposal Field: Distance from nearest well___•.5__0___._Distance from foundation-_-.149____-__.Distance to nearest lomat line- ..~__ <br /> Nu lber of lines___.____ .-_. 9 70--------------Width of french. - _..__.______ - . <br /> -� � --�- Length of each line -- �- -- '�' y --- -� <br /> Type of filter material____R_0(K__Depth of filter material-------- .______.Total length--------------------70_______.___. 1 <br /> i I � .�} <br /> Seepage Pit: Distance to nearest welL1__/QjO______Distance from foundation---151? _____-Distance to nearest lot line_-��___ <br /> Number of pits-------- _"__ -----Lining material--- PISize: Diameter. ___x__tT�-__. Depth_____.. 12--r____..__.__ 3Q <br /> Cesspool: Distance from nearest'eil_________________Distance from foundation___.__..__.___..__..Lining material_...____----------------------.- tJ <br /> —s i <br /> Size:.Diameter______________________________________De th-.------------------------.-- ------.-.---------.._Li Liquid Capacify els. <br /> ❑ r I ; p q P Y 9 � <br /> Privy: Di3tance from nearest well____________________________________ _ Distance from nearest building ______._-. <br /> . . . g------ = <br /> ❑ Distance to nearest lot line--------------------------------------------------- ------------------------------------------------------------------------=------------- <br /> Remodeling and/or repai iqg (describe): - ------- ------------------------------------------ ------------------------ -------------------•------------------------------------ <br /> _ t i +' a <br /> -----------------------------------------------------------•----------•----•--------------------------------------------------------------------------------------------------------------•------------------•---------------- V <br /> ----------------------- <br /> -------------------------------------------------------------------------------------------------------I-------------------------------------------------------------------- -.- --------- <br /> ------I hereby certify that I have prepared this,application and that the work will be done in accordance with San Joaquin County <br /> r <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)- =a'ca`y- a --- t ------- <br /> By: <br /> ` (Owner and/or Contractoi) <br /> B ------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> - s <br /> FOR DEPARTMENT USE ONLY '. <br /> APPLICATION ACCEPTED BY--- '� ' +`�� ------------------------------------------ --------------- DATE-------- --------------- r <br /> REVIEWEDBY----- ------------------ ------------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED--------------------------- ----------------f-------------------------------------------------------.,DATE------------------------------------------------------------- <br /> Alterations andfi;r-recommendations:-- ------ ---------- - -------------------------�-------------- -•�-�---------------- <br /> .w « . �. <br /> ---------- ----------------------------------- - <br /> ------------------------------------------------- --------- ------------------------------------------------------------------- ----------------------------------- <br /> ------------------------------------------- ------- -- -- ----- - --- = - - --------------------------------------------- ----------------------------------------------------------- -- ---� <br /> FINAL INSPECT BY: �;�l,�d�� i's/ `: GEI ! Date I <br /> - ;. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />