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S <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued __r 1_..5 _ <br /> 4Ap� <br /> plica+ionn 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_______"1__._. -- _____-___ G - " <br /> Owner's Name----- F-------- ------------------------------------. Phone------------------------------------ <br /> Address........ <br /> ------------------ - --------Address_..---•- �a � ----­------------- ------- - <br /> Contractor s Name--- A_-�__,=`----- --- ------�5__4:2_%_6----------------------------------- Phone <br /> Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel,0 Other ❑ <br /> Number of living units: _�--- Number of bedrooms __y Number of baths ___�__ Lotssize ___e��d_.____x---,__a_0____________________ <br /> Water Supply: Publicisysterci [Community` system ❑ Private 0 Depth to Water Table ft. <br /> � i <br /> Character of soil to a depth of 3 feet: i Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe H4Hardpan 0 <br /> Previous Application Made: Yes [] No [eNew Construction: Yes ❑ No Q <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> P ( p ' Y p p public sewer is available within 200 feet.) <br /> No septic tank er cess ool ermined if ubli <br /> Se tic T nk: Distance from nearest.well----N47iXDoi-stance from foundation____14---------Material.....��___�____--------A--- _. <br /> GNo. of com artments____..___ Size------- �P____ _ (�Li uid de 'tli_-`__ Capacity--_Y�� <br /> Disposal Field: Disfance from nearest well--/Vff_)t%A_-0istance from foundation-----!_6---------Distance to nearest lot line j_ ..... <br /> Number of lines-----1........_ Length of each line_.__.-_ ,7 ._.___ Width of french----- r_ -_ <br /> Type of -filter material__- __-_,, 'ODepth of filter material-------1.��_________Total length________cam",. __.._-___-...___..__ <br /> Seepa it: Distance. to nearest:well"f t9 r+ --bistance from foundation_. Q__:_.__.Distance to nearest lot line__._-A....... <br /> Number of pits__________________Lining mate ria l _ ie: Diameter_, ___ .----.Depth...... --____________- W <br /> I <br /> Cesspool: Distance from,nearest well-________________Distance from foundation__- Lining material___.______________.____"__________. <br /> El Size: Diameter--------£----------------------------'De th-.---------------------------------------------------Liuid Capacity '--gals. <br /> Privy:' Distance from nearest well__________�____�___________________---------Distance from nea-rest'building---=-,_----..__-------_:--=--} � <br /> �` Distance to nearest,lot:line_.-------- -_ <br /> Remodeling and/or repairing (describe):_------------------------------------------------------_-------------------•------•--------•-- --••---------------------------- -.---- _ I <br /> ____... ft-__-;..----------•---- ----------------- ----------------------------------------------------- --------•---------•-•-------..-----------3------' -- <br /> -------------------------------•------------•--------------------------------------------------------------------------------------------------------------------------•---------------.----------------------------------- <br /> ---------- -----------------------------------------------------} ----------------------•---- — - <br /> 11hereby 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 ru s and'regulations of the.San Joaquin Local Health District. _ <br /> � �- <br /> (Si ne9 ad)------=- - -- ---------•--�---------�--r �-------------- -----------•-------•------------------------------------------------(Owner and/or Contractor) <br /> B -------------------------------- Title-----: -----------------------= <br /> Yom- - ---�D��'�'=-• - ,- (Title) {j <br /> (Plot plan, showing size of let, location of system in-relation to wells, buildings, etc., can he placed on reverse side).' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED.BY----_---------------------------------------------------- h�$'-------------------------- DATE----------•-- ------------------- <br /> REVIEWED BY - ------ - --- �" <br /> -------=----- DATE----------------------------------------------- ------------ <br /> BUILDING PERMIT ISSUED::----::­--'-.- <br /> ----------------------------------------- ------ DATE----------------------=-------------•-- - - <br /> - - --------------- <br /> Alterations and/or recommendations:-------—--------------------- -----------------•-•--•-••-----------------------•------- •----------•- ----------------•------------------- <br /> S <br /> Y <br /> ________________________________________________________________"-___._._._______._______..___..__.....___-___________________-____.._.________________ ..______________________ ___.______._.___________--__._.._---. <br /> ----------_---------------------------------------------------------_----------____------___------------------------------------------------------------------------------------------------------------------------____________ <br /> t <br /> I' <br /> FINAL- INSPECTION-BY:.- ------- = Date------=--------------------------- -.------------------------- <br /> -------- <br /> SAN <br /> _-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Straet 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M ; Revised W-2100 <br />