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FOR OFFICE USE: NN• n <br /> 2 0 11 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ll / <br /> (Camplete in Duplicate) , <br /> -- -.--.••• This Permit Expires 1 Year From Date Issued Qfi" Date Issued <br /> Application is hereby madejto the San Joaquin Local Health District for a permit to construct andinstall the work herein described. <br /> This application is made in compliance with CounfyPpinance No. 549, t05--�Lk(O-pt f <br /> JOB ADDRESS AND LOCATION.-�i�/.� ----�:_.f/ <br /> ' Owner's Name.-•-------- �/ ...T.-. --------- _. .......... Phone�7!'_�!�� <br /> Address.. <br /> ... -----------------•--------.----••-------------•••-----•---------- <br /> Contractor's Name... ....... �� ,.j <br /> t`. <br /> i - Phone.... ��_. ..... <br /> Installation will serve: Residence `Apartment House ❑!Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> d`• <br /> Number of living umfs: ___.�. Number of bedrooms ..,Number of baths . Lot size _.. L�jfP• i'QG ___________________• <br /> Water Supply: Public syst m ❑ CommURiit)Nk ystem ❑ Private [jK Depth to Water Table,��� ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑`,.Sandy Loam❑ Cloy Loam 9 /Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date.....................TLNo IV New Constru&;or.:-Yees No f- FHA/VA: Yes ❑ No!� <br /> TYPE OF INSTALLATION ND SPECNCATIONS:� <br /> (No septic tank or cesspool permitfedirif public sewer is%vailable within 200 feet.) <br /> i =•- <br /> Septic Tank: Distance!from nearest ell.:.. ._....!bistar from foundation-...................Material-------------- .. _ <br /> I ❑ No. of compartments........._ ---- ---Size_.r�.....................:...Liquid depth-------------_---- ---Ca aci. ! �..% p fy-------------------�•I <br /> Disposal Field: Distance from nearest well.-�� _Distance from foundation.._5 ..._.._.Distance to nearest lot line......_1�_....... <br /> ! <br /> Number:of lines.....__.__._...- Lengtlirof each line......�_.'�_._.._...._.Width of trench..._.A�`�................' <br /> Type of'filter material.. ..e tail`'...__Depth of filter�material...41� _Total length.......__4 ............ ..... (�f <br /> Seepagg Pit: Distance,to nearest well..ra_�'..�_..Distance fr�i�+ foundation.. .__-. istance to nearest lot line...__v...�. <br /> Number of pits-•.._____L.......:.Lining material-. /, ,�+_ Sii: Diameter. °�.-". Depth_. , -�.-___--.{ <br /> Cesspool: Distance�from nearest well.................Distance'from founda+ion._..___.._._._.-. Lining material......................... <br /> ___...._.__..�❑ Size: Dia'mefer_.... ._..... Depfih... Liquid Capacity.--------- gals. <br /> Privy: Distance from nearest-well..........................__-.__.-.-... .-------Distance from nearest building. <br /> ............. .................... <br /> N❑ Distance:to nearest lot line._ ................................................ ...................................... -......---......... ------•-----..... -- -- ' <br /> Remodeling and/or repairing (describe):.......... ,.---._f ------- /„ �rj�l�' <br /> ........................................- -..__... ----- ---.------------------------•---•• :... - �..._ . <br /> - ------------------ ........................�= --- ...... <br /> ------------- -.. <br /> d' a. <br /> I hereby certify that I have prepared this application and that a rk will be done in accordance with San Joaquin County <br /> ordinances, Stat d les end regulations of t/Saoa in Lo I Health District. <br /> a <br /> (Si ned <br /> 9 } �� ..... Q.C,tlr ��r.....-•----- ---.O ra/nor Contractor) <br /> By:....................... ----- -------- - . ..-----------.(Title}.._... - <br /> (Plot plan, showing size o ion; locationroyst m in t}elation to wells, buildings, etc., can be placed on reverse side). <br /> v� FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------4��............... L <br /> DATE._ �./.. x—/e_e. ..-------- <br /> REVIEWED BY........................j... .... `---- <br /> -- ------------------------__--- ----•------._--.....--- ------•-•----- --- DATE--- <br /> BUILDINGPERMIT ISSUED.. ................... - ................ ...._---------•----^.....--•.----•------ Y DATE..................... ... .............. <br /> Alterations and/or recommendations:........_.... ° i <br /> ------------ --------- <br /> n� --- <br /> yy <br /> _................................ <br /> .............. ..� ..:..----------------- <br /> ' y / <br /> FINAL INSPECTION BY:--- ........... ...........`........ Date......j_/_.is j.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT II <br /> ' 1601 E.Hosoltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />. Sloddon,California Lodi,California Manteca,California Tracy,California <br />