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FOR OFFICE USE: <br /> ----- ---- --- <br /> ------------------ --------------I I <br /> APPLICATION FOR SANITATION PERMIT Permit No.C�`�'=° a-U-U--- `3t, (Complete in Duplicated---------------------• - ------------------------------ This Permit Expires i Year From Date Issued <br /> Date Issued -------------­-------- <br /> Application <br /> _--___----­--------Application is hereby made to the Sen Joaquin Local .Health Districta permit to con trust and install the work herein described. <br /> This application is made in compliance with County Ordina No, 49, � � 93 <br /> J08 ADDRESS AND LOCATION ---------1/ ----------- ..... <br /> --------------�t-�------� -------- r�- <br /> Owner's Name_------------------••- �.�='=3--•-•-•----1f <br /> - -•--.....----.................................. P ----- <br /> Address_. <br /> Contractor's N _ ----- -------•---•---..........-••-•---....... Ph L__ _._ame.....! '_ -{ � <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: - Number of bedrooms ��Number of baths - /4-Q <br /> -._ Lot size -•---�----- •---•-•-•---•....-•-• •.................... <br /> Water Supply: Public,systemXCommunity system ❑ Private ❑ Depth to Water Table.- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loarrfj2r__Clay ❑ AdobvIK Hardpan ❑ <br /> Previous Application Made: (If yes,date__--___--..__-_._) No New Construction: Ye No E] FHA/VA: Yes E] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu icyower is available within 200 feet.) <br /> `- -. <br /> Septic Tank:, Distance from nearest well ..-...Distance fro fou d Pion_-!a�__-_.Material............................................ :. <br /> No. of compartments----�r-------------Size__ � ; --:...Liquid depth.-�7.�.........Capacity.��......... <br /> Number of lines_nearest well-45.b------ Distance rom foundation_.,. .-� Distance to nearest lot line_._. <br /> ......-. <br /> Disposal Field: Distance from ne# Length of each line--P-0- __Width f--..-.Width of trench-- _---�`.............. <br /> Type of filter material----- - - - -----depth of filter material----2 __--------Total length........--f9_p_ •----__.__.-___.-- <br /> Seepage Pit: Distance to nearest ff well --.--__-Distance rom oundatior��e_--_.._...Dist P� +o nearest lot line__ _----. <br /> Number of pits.__-1---------------Lining material---___ - -_ ____._5ize: Diameter---"01, ----Depth------Aa.. _---__----.... <br /> Cesspool: Distance from nearest well-----------------Dis#anse fro oundation..-.-.-.__------_-_.Lining material------------------------------------- <br /> 11 Size: Diameter.-- I--------------------------------Depth---------------•-------•----------------------------Liquid Capacity---........................gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building---------___---------.................. <br /> IDDistance to nearest lot line--------------------------------------------- ----------••--_---------•- --------------...-------------•---•---••--------------•---•-------. <br /> Remodeling and/or repairing (describe):-------------------------------------------------------•---•---•-••---------------•-•---•---.................... --------------------------------- <br /> t ` <br /> -•---••-----------•------•---•--------------------•----••----.... ------•---•-•-----•-•-----•---------------------••--------•--------------....---.-.....------------..-.....-•-----------••-•----•----- <br />- i <br /> ..-...--•-----••-------.....--..-•-----------------------------•----------•------...------------------------------------.--------------------..........-------------•----..-..-------..----------------••--• -•---------- <br /> t <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, S a la and rules and regulations of the San Joa uin Local Health District. <br /> ci <br /> "ned - -�T <br /> Si V- <br /> 9 ) Contractor) <br /> -- ---- - ----- -- --- ------------------------------ ----- <br /> By: ---- ------------------------------ ----------------------- -------------- ---------_ ---------- ---------(Title)----------------------------- <br /> (Plot plan, showing size of lot, location of system in relation wells, buildin , etc., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- --- ------- ---------------------------------------------------------------- DATE--------- <br /> REVIEWED <br /> -------REVIEWED BY--------------- ------ •--- ------------------------------------------------------------------------•-----••-•------. DATE----------------- <br /> ----------------------------------- <br /> BUILDINGPERK41T ISSUED....,......------------------------------------------------------------------------------------- DATE............................................................. <br /> Alteratioand/ recommendations:---------- - -----------------------------•---------------------------------------------- -•------•-------------------------------------------- <br /> ---------- <br /> -...------------------.--.---------------- <br /> --_.----- ------ ---- e.-------t-:.,A?_��'e<---- <br /> --_ <br /> -�----s�-`�� • -•- -- •�..��---------- - -•f ---------- - ---- - -- • -........----fir:.---•--------•-••--------- ----�-�-.-, r <br /> --------------- --------- ---------- ---------------------- T <br /> FINAL INSPECTION BY:....--/.. .'....X.4--�----------------------------- Date------------r 7 /-ec��� <br /> II SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Stroh 134 Sycamore Street 305 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB 9 REVISED B-59 ZM 5-4[ ATLAS <br />