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Permit No S?7 15w <br /> APPLICATION FOR SANITATION PERMIT ------------- <br /> (Complete'in Duplicat6) Date Issued ___/-l/ �`'� <br /> 11 4 _ 111 <br /> 'I?aquin Local Health District for a permit to c <br /> oa nd install the work herein described <br /> Xpplical,ion is hereby made to the San..,, <br /> This application is made in compliance County Qrdinance No. S49. <br /> -------------------- <br /> - ---- --- - ---------------------- P <br /> JOB ADDRESS AND LOCATION --i-.------ hone--- <br /> -----------7_ <br /> --------------- <br /> Owner's Name------ ------- .i" �e :--------------- -------------------------- <br /> t I---0a--- --------------------- ---- ------------------------------------ <br /> Adclress�----------------------- -------------- ---------------- Phone.-----•----------------•----------- <br /> ---- ---------- ----------- <br /> Contractor's Name----- ---------------------A p-a-rtment-House 0 Commercial n Trailer Court ❑ Motel 0 Othe <br /> ❑ <br /> Installation will serve: Residence F1 --------------------- <br /> INumber of baths. -------- Lot size ------------------------------------- <br /> Number of livingun;ts: -------- Number of bedrooms <br /> te E] Depth to Water Table -------- ft. <br /> Water Supply" Public'system F1 Community system 0 P'riva Clay E] Adobe❑ Hardpan E] <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] ,Sandy Loam El Clay Loam El <br /> Previous Application Made: Yes n No [], New Construction-. Yes F1 No F1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200'feet.) -------- ........ <br /> Material-------- -i;; <br /> e from foyndat;on_ __h)n- ----- ity ------- <br /> ank: Distance from nearest well------5� ------Distanc q -- <br /> -4n---------------Capac <br /> Septic T No of compartn4e is -----Liquid depo <br /> n ....... ...L------------ �,d r est lot line_________________ <br /> -_Distance from foundation--------------------Distance to near <br /> Disposal Field: Distance from nearestof each line__.___._.F --,( _Width of trench- -------- ------ <br /> ._0_j eo- 1�1 <br /> Number of lines----------- Length .---.Total length--'------- ----------------------- <br /> ---------------- _-----1�y <br /> -------------Depth of filter material- <br /> Ty�e T filter material-----VA- 4" sf'a-niceffrom-fc,C676at�cn-------------------Distance to nearest'lot line----------------- <br /> Seepage Pit: Distance to nearest well"-___.----------------- 'i.al ......... Diameter----------------- ------Depth--------------------------------- <br /> Number of pits----------------------Uning mater <br /> F1 I ---------- <br /> --------Lining material------------------------------------- <br /> nearest well-----------------Distance from foundation. Is. <br /> Cesspool: Distance from I ----------------Depth-------- ---------------------- ----------------------Liquid Capacity_-------------------- <br /> F1 Size: Diameter--- <br /> Priv <br /> iameter-­ from nearest building-'------------------------------------------ <br /> IS. <br /> Distance from n I Barest well------------------------------------ ---------Distance ff ----------------------------- - <br /> _________________------------------------- -------------I-------------------------- <br /> Oistance-to nearest lot line--------- ------------------- -------------- <br /> ❑ <br /> ---------- <br /> - -----------------I--------------------------------------------------- <br /> Remo <br /> Remodeling and/or repairing (describe):-------------------------------------------------------------------- -, ------------------------- <br /> �1 % I--------------------------------------------------------------- ---------- <br /> ------------------------------------------------------------------------- ------------------------- <br /> ---------------- <br /> ------------- <br /> ------------------------I <br /> --------------I--------------------- <br /> .......... --------------------------•------- <br /> --------------------- ---------------------------- ­- .11 - — "t—.-�-- � ----------------I------------------------------ - <br /> -------------------------- IQ-i - ----------------I--------------------------------------------- <br /> ------------------------------------ <br /> ----------------------------------------------------------------- that the work will be done in accordance with San Joaquin County <br /> I hereby.certify that-1 have piepare8 +his application and uin Local Health District. <br /> ces, e laws" Is and re lations of the San Joaq <br /> ��Iaf <br /> ordinances,151Y net and/or Contractor) <br /> -------------------------------- <br /> ------------------------ <br /> (Signe 0 <br /> ------------------------------------------------------------------------ <br /> d)--- -----------------------(Title)---------------------------------------- <br /> ------------------ <br /> By-------7_--------- ------------------------------------------------------ , etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot, location of!sysfem in relation to wells, buildings <br /> FOR DEPARTMENT USE ONLY <br /> DATE---------- ----------------- <br /> -------------------- <br /> APPLICATION ACCEPTED BY.__..-_-"-------'--------- ------- ------- I------------------- --------------- <br /> ----------------------------------- <br /> ------ <br /> --- <br /> REVIEWED BY---------------------------------------------------------------- ------------- --------------------------------------------- DATE------------------- -------------------- <br /> DATE---------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------- --------- ----------------------------------------------------------------- <br /> Alterations and/or recommendations-------------------------------------- ------------- ------------------------------------------7----­----------- <br /> ----------- --------------- <br /> ------------- ------ ------------------------------- -------- ---------------- <br /> ----------------------------------I------------------------------ ------------------------- <br /> ---------------------- ------------------------------ <br /> •-------------- <br /> 1 <br /> ---------- <br /> ---------------- <br /> --- <br /> ------------------------1 ------------- <br /> ---------- - ----- ----­ --------------------------- --------I-------------- - <br /> ........­ <br /> ------- --------------- <br /> ----------------------------------------------------------------- - - - ---- <br /> I ---------- -------- -- ---- <br /> ----------- <br /> -------------------------- <br /> ------- <br /> --- <br /> ----------- --- ---------------------- ---- <br /> -------------- <br /> -------------- - - <br /> Date----------- --------------- --- ----- <br /> ----- ----------------------------- <br /> FINAL INSPECTION <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 sycamore Street 914 North "C" Street <br /> 300 West Oak Street Manteca, California Tracy, California <br /> 130 South American Street 'r <br /> Stockton. California Lodi, California <br /> cc! o_17kA Revised W-2.100 <br />