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APPLICATION FOR SANITATION PERMIT Permit No. ._� '-8' - - <br /> a' (Complete in Duplicate) <br /> ' Date Issued -------Y(-I-----,(�_S_ <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 wit Count Ordinance No. 549. <br /> k <br /> JOB ADDRESS A LOCATION_-_ __.__ I�os ��� <br /> T _______________ ________________-_ <br /> Owner's Name ' - --•----- . <br /> -------------------Y_ <br /> 14. <br /> ----- Phone-- ------ --------------- <br /> Address............./-- --�-- �--- -------- <br /> ----------------:------------ --------------------------------- <br /> ------------ <br /> ontractor s Name____ ____ _____� - <br /> p <br /> �. -- - --------------_-------•-- Phone.-.---------------------•--------.. <br /> Installation will serve: ' Residency' Apartment House ❑ Commercial <br /> � ❑ Trailer Court ❑�M fel ❑ Other ❑ ` <br /> Number of living units: J--- umber of bedrooms <br /> .... Number of baths ! it Gj "rn <br /> ------ Lot size . t <br /> Water Supply: Publics stem Community s-sfem <br /> ` y Y Y ❑ Private ❑ Depth to Water Table-'--,_-_ ft, <br /> r <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam.F Clay [] Adobe Hardpan ❑ <br /> �► <br /> Previous Application Made: Yes ❑ No New Construction: Yes [(No ❑ FHA/VA: YesNo <br /> of t;trTYPE OF INSONS: <br /> TALLATION AND SPECIFICATI ❑ <br /> (No septic tank or'cesspool permitted 'f public sewer is available within 200 feed.) <br /> Septi, 6nk: Distance from nearest well__ <br /> Dista ce from} fo tion,/1--- -_----.Materia <br /> No, of com artments_ __ <br /> p T ------'. t' � Liquid lept ----- <br /> ------- <br /> - - ------ ------Capacity--.. <br /> Dispos Field: Distance from nearest wel - __ <br /> \istance from foundatianT -- 'Distance to nearest lot line,. ; <br /> Number of lines_______ _ I-------------- <br /> ------------Length of each line----------------- ---_0--_ Width-of french_._.---•. _ <br /> Type of filter materi a }t <br /> ------------ <br /> [}epth of filter material___ --� ----- Total length------------- -Q_-- , <br /> Seepage Pit: Distance to nearest wall'___'"""''_ _-'Di'tarice from foundation'_=__w'_._= <br /> ------Distance to nearest lot line___.----_------- <br /> ❑ Number of pits Y Lining material --------Size: Diameter:___`__`-`'�- Depth <br /> I: Distance from nearesf`well______________ _ <br /> ❑CesspooDistance from foundation-_____ ____ ______Lining material__--__ <br /> Size: Diameter " `------_-Depth--------------------=------ - <br /> Liquid Capacity---------------------- '_gals,; r <br /> Privy: Distance from nearest well-------------------_----_----_ -_ _ _ _Distance from nearest 'building 9 -- - <br /> ❑ Distance ti nearest lot iine�.-~•^' �-- - <br /> q <br /> Re madeli and/or repairin fdescribe)--------------- <br /> -- _T__-- --- - 11 <br /> ------ ---------------------------• <br /> ' <br /> ------------------------------------------ <br /> --------------------------------•-=------•-----•-•-------------•- ------------------ <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. { <br /> (Sign ed) + <br /> ' -4---- ----- <br /> Plot �-----------------------------•-- - � ----------------- --------,Ie�---------------- -------- (Owner r ontr <br /> -- __{O rand/o actor) <br /> -------- -------------------------- - <br /> - --- - --------------------- -----frit ---'--------'----------- --- <br /> ( plan',Bshowing size of lot, locafion'of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR pEPARTMENT USE ONLY {` <br /> REV <br /> APPLICATION ACCEPTED, BY=- ---- --- ----------------} <br /> • ----------- DATE -------- ---------------------------- <br /> D BY ------------------------ ' ---------- DATE_ - <br /> BUILDING <br /> PERMIT ISSUED, = ------------------------------=----------- ------------- DATE---------- <br /> Alterations and/or recommendations:----__ �,G•(-�------5 �� �r �p Y,!• �_t'f_..--F----3- -- <br /> / __�.�_-. t. <br /> ----- rfJ_�. � !i�C� �'.4s���J -� �c1= G:r;�:r _ j........ ...... . <br /> -----------------•---------•---------------- •--------- <br /> --- -----------------------------------*-------- <br /> ---------------- <br /> - <br /> --------------------------------------- <br /> FINAL INSPECTION u•,, Date....-----__ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 S luth American Street 300 West Oak Street i32 Sycamore Street <br /> 814 North "C" Street <br /> S}ickton, California Lodi, California Manteca, California <br /> Tracy, California <br /> ES-9—•2M . Revised 1.57 F.P.CO. <br />