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APPLICATION FO <br /> !R SANITATION PERMIT Permit No. ...... <br /> (Comple�.fe in Duplicate) <br /> Date Issued -------- ----------- <br /> lica4-ion is hereby made to the San Joaquin Local Health District for 'a e it to construct Wandin '�141he work herej! described. <br /> This 13application is made in compliance with County Ordinance, No 9 _p rm <br /> JOB ADDRESS Al��OCATION-------- I-- ----- . ........ ............. <br /> -------- --- ----- --------------- ---- . .... . ...... <br /> I - -- ------- ------------- <br /> Owner's Name- -------- ------ ---------- --- -- ---------------------- Phone.W�� <br /> Address-------------- - --------- ------ - --- -------- N, <br /> -----k- --_�./ - A --------------7 -----------------------------------------------7----------------- <br /> Contractor's Name--- ----- ----- - - -- r--- -Z--/--------I--------------------------------------------*------ <br /> ------------------- Pho <br /> ne./�/ <br /> r - <br /> Installation will serve: Residence Apartment House E 'Commercial ETrailer Court EMotel _ - <br /> Other ❑ <br /> Number of living units: Number of bedrooms -2,­'Number of baths J_____ Lot size ------------------------------ <br /> Water Supply: Public system Community system El ' Pfivate Ej­ Depth to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: , Sand E] Gravel I-] Sandy Loam Ej Clay Loam E] Clay 0 Adobe r'01 Hardpan ❑ <br /> 3 <br /> Previous Application Made: Yes E] . 14 0 � New Construction: Yes F] No .7 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank-or cesspool permitted if public sewer is available wifkin.200 feet.) <br /> Septic Tank: Distance from nearest well- _:----------- Disfalrice from foundation----------------------Material---------I------------- <br /> ly7 ---------------------------- <br /> El eX1 No. of compartmen'ts------------------------- Size__� -------I----------Liquid Jeipt'h--------------------------;Capacity------------------------ <br /> Disposal Field- Distance from nearest welJ_WWYA:__.Disfa'n� ce from foundationi---9 -------Distance to nearest lot Iine__�47 <br /> . 11 <br /> Number ci� lines----C?-Le-_40.)-------------- of each lline--, Width of french_..-_2,//__/1 <br /> 19 --------- ------ ow----F I. �-t -- <br /> 4 Type of filter of filter material__'1__ ___________Total length___-_ .---__------_-_.,,_-__------.- <br /> Seepage Pit: Distance to nearest I well---?1, -�_ __Disfance from fo.unafion-----I�Q...+-..Dis+ance to nearest lot line_________ <br /> Number of pits---------I-----------Lining M'aferi�l-Ce-p,-,.-3-)4-Aize:'Dieirneter----i�3�.. --------Depth___.1-_4---------------------- <br /> Cesspool: Distance from nearest well-----------------Dista-rice from foundation----- --------t___Lining material----------------------- <br /> 11 -------------- <br /> ❑ <br /> Size: Diameter------------------ -------------------Depth----------------------------------------------<-----Liquid Capacity----------------------------gals. <br /> Privy- Distance from 'nearest well------------------------------------------------Distance from 'nearest building------------------------------------------ <br /> ❑ -Distance to nearesf'Iof-Iine___'___-__.:---------------j <br /> ---------------------------------------------------- <br /> Remodeling and/or repairing (describe <br /> -------- <br /> -------- --- - -------------------_---------- <br /> ---- ------ -------------- ------------------------------ <br /> -------------------------------------------------------------------- --- ------- <br /> --- --------------- ------------ ---------------- --------------- ---- ------ ------------------------------ <br /> -------------------­I----------------------------------------------------------------------------------- --------------------------------------------------------- ------------- --------- <br /> ----------------------------------- ---------------------------------------------------------------- ---------------------- ----------------------------------------------------------------------- --------------- <br /> I hereby certify that jlSap"r*'__ d <br /> �d les pare this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State lawsran rules regulations of the San joaquin Local Health District. <br /> ------------ <br /> (Signed)-----. - ----- -- ---77--------W�- ---------- �?----------------------- (Owner and/or Contractor) <br /> By:----------------------------*7i <br /> I------------------------------------- <br /> --------(Title)-------- ------- <br /> (Plot plan, showing e of ko , o,, on of system in relation to;wells, buildings, efc., can be plat on-reverse side). <br /> ;wsand ules odl <br /> size <br /> FOR DEPARTMENT USE ONLY ' t <br /> APPLICATION ACCEPTED BY- -------------------------------- ------- ------------------­---------- -------- DATES_- ----------------------- <br /> ---------------------------- <br /> REVIEWED BY------------------------------ <br /> ------------------------------------------------------------ -------------------- DATE---i!t�-------- <br /> BUILDING PERMIT ISSUED------- -------------------------------------- V.% <br /> ------------------------------------------ DATE---------Oxx-----------I---------I------------------------ <br /> Alterations and/or recommendations:----------------------------- ---------------------------------- <br /> --------------­----------------------------------------------------------I-----------_------ <br /> ------------------------------------------------------------------------------------------------------I......I----------------------------------------------- ------------------------------------------------ <br /> ----------------------------------------------------------------------------- ----------------------------I---------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------- -------------------------------------------- ----------------------------------------------------------------------------------- ----------------------------­ <br /> ------------------------L�--------------------------------------- -------I------ ------------------------------­------------------------------------------------------------ ------­-----------------------I--------------- <br /> LP <br /> FINAL INSPECTION <----------- Date.... ------------ <br /> -------------------- ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Sfreef <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M ; -' Revised W-2100 <br />