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APPLICATION FOR SANITATION PERMIT `` Permit No. <br /> (Complete in Duplicate) Date Issued - f/../} <br /> Application is hereby made to the San J utn Local Health District for a permit. oconstruc and install the work herein described. <br /> This a licatiori is;made in compliant t County Ordinance No. 549. n 2-ZlpfJ—! l <br /> -----47 <br /> JOB ADDRESS AND LOCATION....:__.._,_�_^�7..__._:_.._.._ <br /> tr <br /> Owner's Name --� a ..._.... ...♦ <br /> Address---------T�- ------ - ------ --• - - - .... <br /> •t f. <br /> Contractor's Name....... t :.._.. Phone f <br /> ---•-•-----------.......... <br /> e. <br /> Installation will serve: Residence ❑ pf A4ment House,.❑ Commercial,C] Trailer Court ❑ Motel ❑ Other <br /> Number of living units: . -..�_�Number of bedrooms _.:.�- Number of <br /> baths ...---- Lot size ._w ...................................t.: � <br /> Water Supply: Public system ❑` Community system ❑ _Private ; Depth'to later Table F 'ft. i <br /> Character of soil to a depth of 3'feet: Send.Q Gtravel ❑;_Sandy;Loam I]JClay Loam Q Clay❑ Adobe INr Hardpan ❑ <br /> Previous Application Mader Yes 0 N New Construction: Yes j No El FHA/VA; Yes ❑ NNc <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: % t <br /> [No sop+ic +ank or'cesspool permitted'if.public sewer is available within 200 feet.) t F�y y 1 <br /> ♦ _ r� ..... __ i {�Cy/•�_J <br /> r� <br /> Septic Tank: Distance from nearest well__.. _._._.___Di tance from foundation�?.~-A:.......Material..._. d ------••- <br /> / -- <br /> r ,Z ..._.�size_... _,7_ '' _r��Liquid iiepth..._+-lr �1 Capacity---- <br /> No. <br /> of compartments...... ... ...... � ! <br /> Disposal Field: Distance from nearest well-.. _ I_ _.Distance from foundation----J.o___---Distance to nearest lot line---ti/Q:'R. <br /> Number of lines....-....... ....... ......... Length of each line_ <br /> __. ;� --��-- =-----•Width of trench.. ------------------ l <br /> Type of fIter offilter material-. r --y _:_.Total length..'......L-0_©______-_..__--_-_._ <br /> Seepage Pit: Distance to nearest well....................!.Distance from foundatton.-----_-----:-.:...D.istance'to nearest lot line................. _X� <br /> (l Number of pits.............. Lining material---.___------ ----- Diameter.................. _ .Depth_............_..........._...... n <br /> Cesspool: Distance frorn nearest well................Distance from foundation.. ...........-._.Lining material................_.._--------._---.-- <br /> Q Size: Diameter ----- ------ --• •............Dept h................- --------- ----------- `.'Liquid Capacity............---•--- ...--gals. <br /> Privy: Distance from nearest well•_ _.------------__........ .........Distance from nearest building...................-.---------------------i . <br /> _... _ ......... -----------•------------------ <br /> Cl - Distance to!nearest lot line...... ......._`___.-.--•------------ .......------- <br /> Remodeling and/or repairing <br /> _ _ . . _ _.. 4:A. I <br /> ......---•-------•-...._, .A_. ".. .. �eL.r.............1 �A-----••--------- .—._----- --_ . , I" <br /> . - <br /> ---•------- <br /> 'I hereby certify that I have-prepared this appiication and4hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, , nd'rules and regulations of the San Joaquin-Local Health District. 4 <br /> -------------------------- <br /> t t • <br /> (Sign )�------- - ...:.::.:.F =f"d +'�--`=- =---•------------ -------- (Owner and Con+ractorj� <br /> S� ned r <br /> Z ,4.- r.... ._ <br /> BY: <br /> - 1 (Title)------------•-----.... <br /> _, ..............----- <br /> (Plot plan, showing size of lot, lata+ion of system in relation to wells, buildings; etc., can be placed on reverse side). <br /> 1 <br /> FOR DEPARTMENT USE ONLY ;! <br /> APPLICATION ACCEPTED BY I'/--------------_--- DATE.----------------�.. ..�.._.... .. <br /> REVIEWED BY fi- 4 1 ,�J. '................- --- DATE I -.. <br /> ! �'v -1 �� <br /> BUILDING PERMIT ISSUED--------------- ------------ d-- , <br /> DATE..----•-. ----••---••------- --------- --------------- <br /> Alterations and/or recommendations:..................... ._ ----..•--•---•--._.... <br /> -.- .-.-.•.--------•-- --------------- -----_..........._....-- <br /> t .................... <br /> ► -----------------------'----- --------------------,................ <br /> ;. :.._.....'..----=----.'...............................•-• -----------...... -----.......-----......... <br /> { <br /> _ - 77--------------- <br /> Date......._• ......... <br /> FINAL INSPECTION -BY-.-...............:-:':- ....:-----......�.- ----- • , <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, <br /> Manteca, California Tracy, California <br /> ES-9-2M , Revises 1.57 F.P.CO. ` <br /> - - K <br />