|
FOR Of FICE USE:
<br /> y9
<br /> ...............................
<br /> 4 .4.�4-V......................�:.3.o. APPLICCATION FOR SANITATION PERMIT Permit No. ..../.
<br /> . ............................. . (Complete in Duplicate) Date Issued ...711L.$�
<br /> ... ......... . . This Pormit Expires 1 Year From Date Issued
<br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed.
<br /> This application is mad in c tpl' a with County Ordinance No. 549.
<br /> �/' _ 3�
<br /> JOB ADDRESS AND LOCATION.. . -..C�. /r-', ...... .1 .... .,yl ../,j).,�'
<br /> Owner's Nem ,-- .td4•.4/r.�... ; F
<br /> �•
<br /> Contractor's Name...., ....:. lj;/ f/ r.2,,�............... ... . ... ...... ............................................ Phone................................. `
<br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑
<br /> Number of living units: ..... Number of bedrooms .. Number of baths J.. Lot size .............i..•......•...,..•.... ...
<br /> Water Supply: Publics sten ❑ Communify system ❑ Private �''6epih to Water Table � ! .
<br /> Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe Q1'Hardpan❑ t
<br /> Previous Application Made: (If yes,date. _ _ _. ► No New Construction: Yes Q-- o ❑ FHA/VA: Yes D--No❑
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS: s
<br /> (No septic tank or cesspool permitted ?f public sewer is available within 200 feet.)
<br /> Septic Tank: Distance from nearest well... 11,.... Distance from foundation. . ..
<br /> y
<br /> Q� No. of compartments...I...pp.............Size,'a)x,.X>5.-/, F< ..Aiquid depth...... ............Capacity,�.l...�l_rJ,.... .
<br /> Disposal Field: Distance from nearest well0..a.,.....Distance from founda�a./ "":,..Distance to neareslot
<br /> 'a ,� ....
<br /> Lenqf
<br /> YPe of filterNumber of I nmetara�� C' .Depth hofffilterlmlaterial...,rl .... .�...:otalthlength.n/....................» ... f
<br /> i
<br /> Seepage Pit: Distance to nearest well..../..kt��....Distence,fy�m 10 ndetion....���...»..Distance to nearest lot line.
<br /> Q� Number of pits..................Lining material.. �)j..Cr...Size: Diameter..,� ...,.......Depth.�o5 .. r_.
<br /> Cesspool: Distance from nearest well.................Distance from foundation...................Lining material.....................................
<br /> ❑ Size: Diemciter... . . ............. _ .....Depth....................................................Liquid Capacity............................gals.
<br /> Privy: Distance from nearest well, .... .....................................Distance from nearest building........,..................... ...........
<br /> ❑ Distance to nearest lot line . ...............,........................»..,.....». _,..... ...._...•........»..........,..._...............-.......
<br /> repairing (describe): / /�� '
<br /> Remodeling end/or re......................».... .... ....»........................................................... ...............•...,...,,..................,...».............».......,,.,......,...........-............._........�'
<br /> i ,
<br /> . ..............•........................................................................................................_..».........................».........--.....«...........................................
<br /> .....
<br /> .......................................... .............................................................. .....,.....,.....,.....................................................,..................................... ta.
<br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Cou
<br /> ordinances, State laws, andrr les and/regulations of the Sen Joaquin Local Health District.
<br />(Signed)............. ..... .!�• �• :. . �' (6�rnerea Contractor)
<br /> ........................................................
<br />(Plot plan, showing size of lot, location of system in f ation to wells, buildings, etc., can be placed on reverse side).
<br /> FOR DEPARTMENT USE ONLY —
<br /> APPLICATION ACCEPTED BY... ............
<br /> rim! ._.. ............................ DATE.......... .•,......,., ... .. ...
<br /> ..........
<br /> REVIEWEDOY.. DATE...................................................»....... t
<br /> BUILDING P''RMIT ISSUED............................................... ............_ DATE
<br /> Alterations a jolor reeommendations:....ln... '���! ,�`� —'�F ....F4`rt.
<br /> .. ..•.. .t.......... ......................,....... ............ .- ...... ..... .
<br /> t- .-..r '..,..<.-.,./...0..............» ........................»......f.._.»...............................-.........»...
<br />. ..... .. .. . .
<br /> .. .................... ....,.,............................................ .. .. .............................................
<br /> » ......................................... . ..................................
<br /> Fli INSPECTION BY:.X., /._ ./.1.. • '� Oat@.....
<br /> . . ,.`�,(�. s..
<br /> ..
<br /> fr
<br /> �AN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 1601 A.Hazolien Avo. 00 West Oak Street 124 sycamore Street 203 West 91h shoat 7
<br /> S1a6110n,California Lodi,California Manteca,California Tracy,California '�
<br />
|