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1 � Permit No.c��.._�^. <br /> APPLICATION FOR SANITATION PERMIT <br /> �j (Complete in Duplicate) Date Issued <br /> �� Q i� i • herein described, <br /> b made to the ,ioaquin Local Health Distpict for aa_peymit;to construct,and install the work e <br /> �Applicatio is here y i, � •� � � �/ � <br /> This application is made in compliance with County Ordi e No. 549 <br /> JOB ADDRESS AND LOCATION_...__._.------------------ ---------------------------------- <br /> t _ _ r � `s<i--`.-- -+�r.I ------------------- ------------- <br /> Name <br /> ----------- Phone <br /> Owners ame---------- ----------- .�... _ -- <br /> a..�...,..,. . .,.�,� . <br /> Address-------•--------•-------_-------­--------------------- ► <br /> -------- Phone <br /> Contractor's Name--•--1--•--------•-------------------• -----------------------t -� <br /> "I <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ 'Trailer Court ❑ Motel El Other ❑ <br /> YNumber of baths ._-___-_ Lot size <br /> �S X /---0----------------------------- , <br /> Number of living units: _"..I__ Nuii ber of bedrooms "" , <br /> Water Supply: Public system ❑ Community system ❑ Private 0141 6gvb�to Water Table "_ "_"_ ft.0 + <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [�' Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes [�' N [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tankior cesspool permitted if public sewer is available within 200 feet.) <br /> I! D'+stance from foundation_--_-- " a Material-._- -' ----- - <br /> Septic Tank: Distance from nealk <br /> est well"" � "" _. <br /> No. of compartments-.--_y- -------------size Liquid depth---------`t�"O._ Capacity-_-__-f.�'va�--- <br /> I Di os I Field: RPtance from neallest well""'��._�-.-..Distance from foundation------e I -:Width ofnce to nearest lot line <br /> ----- <br /> " Len th of,;eachJine __t <br /> <.�-� _ - - ------- <br /> Number of lines-�-----=---- 9.::.3..� _ v , ,� ZQ <br /> k. length �► ; <br /> Type os filter mat�rial"��:_._i' "'-Depth of�fil�er material_."_-_"_/. �__"_._Total ___"" ____-- <br /> W +f 4" t <br /> Seepage Pit: Di4tance to neare�t w�HS"_ Distance foundation--_.__-�"f"_".--.Distance to nearest lot line-------------- <br /> from - <br /> ;- -, <br /> �it Depth <br /> • � -----------------------Size: Dia efer-;.=--------------- - p r, <br /> ❑- Number of pits---------=-----------Linmq material <br /> I <br /> Cesspool: D stance from nearest well"�_.___"-__)"Distance from foundation_____--"�_.Lining material--"""____--------------------------- <br /> - -.De th------------- Liquid Capacity € = gals. <br /> ❑ size: Diameter-- -------------------- <br /> I <br /> ---- P <br /> 1 <br /> PrivDistance from411Awell------ -------------------------------------Distance from nearest building -------------------- <br /> Ys .� It ---------------\-•-- I ----------------- ---------------------------------------- <br /> ❑ Dist,�ance-to neare.,.t.lot�ine.---- ------------------ <br /> E . <br /> R - - 1 = ---------------------------- ---------4Li <br /> Remodeling and/or repairing (des;rile):__" ----- --------------------------- -- to <br /> f ----------------. <br /> �� _ <br /> ---------------- <br /> _` -__-._" --------- ------------1 <br /> 4 . I <br /> ------ I - ------•------------------•------ -• --------------- <br /> --- _ ------- <br /> Ih ` --------- ----- --------- <br /> -------------------------- <br /> I hereby certify that I have pre aced this application and that th`e'�workwiR be done in accordance with San Joa#uin County p <br /> ordinances, State laws and es ana� 3�ulafiomr-a4e S Joaquin Lo6l Health District. <br /> j +C <br /> ---------------------------------------(O er an /or'Contractor) <br /> (Owner d <br /> (Signed) .__�... .: l o <br /> --------------- <br /> (Title, <br /> (Plot plan, showing sire of lot, location of system in relation to wells, buildingst, etc., can be placed on reverse side). <br /> jFOR DEPARTMENT USE ON;LY�� . . _ zzk II <br /> _. .. <br /> I <br /> 1 ' ------------------------(----------------• DATE <br /> APPLICATION ACCEPTED BY-- -------------------- i`REVIEWED BY '." ,.'. "'"" ",� ------------ <br /> I - <br /> r- ". DATE J ---------- - ---------------------------------- <br /> - <br /> -- i <br /> -.�.. \ i DATE-- -- •- -----•---- -------------------- <br /> ----------------------- <br /> ---------------- <br /> `--------------------------- <br /> - . s .--------••--- • 3 ..._- - <br /> BUILDING PERMIT ISSUED------------------*-`-----k- -- _ ---------_""-- <br /> �---z.------•---•---- ---- _ .l " _ . ._ -• --'--- <br /> Alterations and/or recommendatio-ns:__=----__ _ _-----=A------=-------.__. r------ - ­---------------------- <br /> •-------------- <br /> --�-------!f-----------lr`-._-- -------------- ---------------- -------------------- <br /> ii I <br /> --- <br /> ------------=----------------------------------- <br /> FINAL INSPECTION -BY:------- ---------- <br /> ----------------------------- <br /> - <br /> -------------------- <br /> - --------------- - <br /> Date---- --- _/--- <br /> T <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i814 North "C" Street <br /> 300 West Oak Street 132 Sycamore Street <br /> 130 South American Street Manteca, California Tracy, California <br /> Stockton, California Lodi, California r <br /> I <br /> ES-9-2M �0-52 Revised W-2100 �l <br />