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S37Z <br /> APPLICATION FOR SANITATION PERMIT Permit No_ ____________ <br /> (Complete in Dup _________.. <br /> lica+e) / <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a b 0Z-3.2r <br /> This application is made in complian with ounty Ordinance N . 549, construct and install fhplworkk hgrein defcribed. <br /> JOB ADDRESS AICD OCATI® UTi ---- -- � ' <br /> Owner's Na'm �..�._. <br /> --- - ----- - <br /> Address__R • F ----- _._ _ _ Phone. <br /> - -- <br /> - --- -- -- ---- - - ------ ---- - <br /> s.-' .,__ <br /> .-- '------- _ <br /> Contractor's Name_____ .__ -----•-------•----- <br /> ---- --------------------------------------------- <br /> j <br /> ------------•-------- - - --- <br /> Installation will serve: Residence Apartment House Commercial <br /> ------------------------------------------------Phone-- <br /> Number of living units: --1_ 1 ❑ Trader Court Motel ❑ Other ❑ 1( <br /> Number of bedrooms I _" Number baths ___! Lot <br /> Water Su I Public system ❑ Community system r <br /> PPY Y Y ❑ Private Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam [] Clay [I Adobe[Hardpan 0 r <br /> Previous Application Made: Yes E] No Q� New Construction: Yes No E] i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if ub�ic sews`is available within 200 feet,) <br /> ,} <br /> Septic Tank: Distance from nearest wel_ "([ � / <br /> istance fromifoun c�Fion/""1 _- <br /> No. of compartments---------%�(---- t ate i�l__-_-------- "-- <br /> _$ize <br /> y C----------------- epfh--- =_""-- -- Capacity <br /> �} - - -------- <br /> Dispos ' Field: Distance from nearest well[l_ �"� ' -"""-"" - `�#-�- � - <br /> istance from foundation __. _�istance to nearest to lin a <br /> Number of lines___ _-" �y �-----"- <br /> ength of each line--------- ___I�_ Width of trench._.___., <br /> Type of filter materia _ <br /> �epth o` s£Iter,material_--------J-9-- Total length__------""-"-- --------- - ---------- <br /> Seepage Pit: Distance to nearest welt______--------------- Distance Born fou dation-------------------- <br /> Distance #o nearest lot <br /> ❑ Number of pits------=---------------Lining material---I -I- --.:__-. Size: Diameter------ ----------Depth------- <br /> --------------Cess ool; <br /> p Distance from nearest well------- Distance fr6m-,foundstion---------------"__Lining material---------- <br /> --------------------------------- _____ <br /> ❑ Size: Diameter----- Depth---�- -�----� -- ------- -�- - ---- _.- ---- -----g---- <br /> ,• EE ''.'' rLiquid Capacity_._. --- --- <br /> Privy: Distance from nearest well _ :� t _ <br /> -----_Distance from nearest.buiiding.1 1 f-------------------------- <br /> ❑ Distance to nearest lot line'!" --_'�- - ""'-� <br /> ------------------ <br /> Re o I' g,and' or re airin (desc�� e):_ -- •�, / ----------- -- <br /> ------ <br /> 0 , <br /> ---------------•--.---- <br /> t - <br /> - - --- ----•-- - ------------------------------------------------•------------ <br /> I ------ ----- -- <br /> __________________________________________________________________________________________________f__.___-________________._______--__._..._ <br /> ------------------------------------ <br /> I her 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 rules and �egulat'Ons of the San Joaquin Local Health District. <br /> (Signed)-- r I <br /> ----- --------------- <br /> By: <br /> ------------ - , <br /> _ (Owner and/or Con+ractor) <br /> By:.._". ------•---------•--------•-------------------- •-------- --- r / <br /> -------- <br /> (Plot plan, showing size of lot, Iota+ion of system in relation to wells, buildings, etc., canbeplaced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> REVIEWED BY --------------- ------- ------------------------------------------------------- <br /> DATE. ------------------------ <br /> -- ----------------------------------------------------------•------------•------- <br /> BUILDING PERMIT ISSUED_---------•-,:-------"-_"---------------•-------------------------•--------------------------------- <br /> . DATE__-.�- <br /> Alterations and/or recommendations:__.___ DATE-------- ______ <br /> ----- -------•------------------------ <br /> FINAL INSPECTION BY:..____. 5 �, 6- �� . <br /> ---------- <br /> - ate----- ------- �------- <br /> -- ----------------••--••--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes} Oak Street <br /> 132 Sycamore Street <br /> Stockton, California Lod814 North "C" Sfreet <br /> Lodi, California � ' <br /> Manteca, California Treey, California <br /> ES-4-2M 10-52 Revised W-2100 <br />