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APPLICATION FOR SANITATION PERMIT. Permit <br /> (Complete in. Duplicate) � <br /> 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 /> JOB ADDRESS AND LOCATION-_ �_ ��oH �/7e.�" y7�y y7�.y-- <br /> I�,r� �------------=---�--------�-----�----;-.-------�- •- -- z--------- - t---- ---------•-------------------------------------------------- <br /> Owner's Name It_: �_ti<i -------------------- . --- . Phone 2l__7----- <br /> Address----------------------------I-------------­--2;;a -I--------W-•---•,I-----�-'-------- ---------------- <br /> Contractor's Name__.-----•----•--3.0`'�--------------•------------------------------------------------- -----------------------------------------. Phone------------------------••------- i <br /> /%a: - <br /> Installation will serve: Residence (" Apartment House ❑ Commercial ❑ TraiiilJeJr�`Court ❑ Motel ❑ Other ❑ <br /> r Numl ee_4f living units: _-7__ Number of bedrooms __i?i___ Number of baths=_],_____ Lot size ---K---1 5--------_ <br /> -"Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> I. <br /> Character-,of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B--Rardpan ❑ <br /> Previous Application Made: Yes ❑ No B New Construction: Yes BNo ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic�fank or'cesspaol permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance:from nearest well__7 _.Distance from foundation--- _______,___.Mafierial____y`_ ____________________________ <br /> `.No. ofacompartments----` ----------Size__a,. _� -- --------Liquid depth_----Z1------------------Capacity-___R-0 ---------- <br /> Disposal Field: Distance from nearest welly-__Distance:'from foundation----!Q-----------Distance to nearest lot line__��----------- s <br /> ©� Number -of-lines=--------�---- ---- - -------Lang}h,of"each line_____-3------------------Width of french------zy-_--------_---------_- S i <br /> • -- <br /> Type of filter material____3'�----------------Depth of-filter material_____ _______Total length----------- ______________________ � <br /> lig <br /> Seepage Pit: Distance to nearest well.......................Distance from foundation--------------------.pistance to nearest lot line_-___.----_______ I , <br /> 10 Number of pits----------------------Lining material-:_'__'__._._____.Size: Diameter-----------------------Depth--------------------------------- - <br /> Cesspool: Distance from nearest well-_________.____Distance from foundation-------------- -----Lining materia)------------------------------------- J <br /> I❑ Size: Diameter--------------------------- ------- ---Depth--;------------------------------------------------Liquid Capacity----------------------------gals, � <br /> Privy: Distance trom nearest well_____________________________ --- <br /> __.______Distance from nearest building----------------------------------------- <br /> ❑ < <br /> Distance to nearest lot line ' <br /> Rerhodeling and/or repairing (describe:- r== ------------------------- -- ..------ ------------------------------- <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 re ulations of the San Joaquin ccal Health District. <br /> (Signed -- '. --- . -- {Owner and/or Contractor) <br /> R <br /> B • {Tale). <br /> Y• ------------- ---- ---- --- ------------------- -------------------------------------------------------------- <br /> -------------------- <br /> of plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE <br /> - L� ------------------------------- <br /> REVIEWED <br /> `-_----REVIEWED BY--------------------------------------a`-"'--------- - -----= DATE----------------------------------------- <br /> BUIILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------- ----------------------------------------------------- <br /> Alferafions and/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> t <br /> ---------------------•------------------------------------------------------------------------------------- --------------------------- -------------------------------------------------------------------------------- <br /> ------------------------------------------- ---------- ---- - --------- ---------------------- -------------------'..------------------------------------------------------------------------ <br /> FINAL INSPECTION BY------------------ - ---- •----- Date---- 2 -------------------------------------- <br /> SAN <br /> ------------ -- ------ •- -SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revisso 1.57 F.P.M <br /> i <br />