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IJP <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..7 <br /> ... .... <br /> (Complete in Duplicate) <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-- --------------- - ---------- --------- --- -------------------- <br /> ?T- ----- -------------------------------------------- ---- <br /> Owner's Name______________________ 1.4 ---------- ----17?2�_t--------------- Phone---------------------------------- <br /> ZV, --------------- ------------- -- <br /> Address-----------------------------------------------------I----------------------------------- --------I------------ Th------------------------------------------------------------- <br /> Contractor's Name------------------------------------------0__t-_0N_e_y-------------------------------------------------------------------------- Phone-------------------- -_--------•- <br /> Installation will serve: Residence U/Ap6rtment House Commercial E] Trailer Court E] Motel E] Other <br /> Q' ' <br /> 2- --- ------ /�._..l_-�_�_____..____ <br /> Water <br /> of living units: -j- Number of bedrooms------ Number of baths ---I--- Lot size ---- <br /> Water Supply: Public system-�/Clommunity system 0 Private E] Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: SnNew <br /> Gravel El Sandy Lo Clay Loam [-] Clay [] Adobe t�14ardpan 0 <br /> Previous Application Made- Yes F ;/No El] No Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS; (A� <br /> (No septic tank or cesspool permitted if public seyfer-i"vailable within-2004ee+i tTil <br /> Se k: Distance from nearest well __-___�Disfance from foundation____!__40 ------- a eri I________ _____ _________ ___ _________ <br /> No. <br /> -------- <br /> No. of compartments..----- Size---j,0Lit qu i d d th <br /> ()L_2.2p�n--- ----- ------------ - apacity---- -------- <br /> Disi Field: Distance from neares ----dA------.- isfance from founclafic/53W --- istance to nearest lot lige------- <br /> Number of lines_________)----- Length of each line_.______ idfh of trench. __________________ <br /> Type -length----- I----------- <br /> Type of filter material--- Depth of filter material_______ _-____' <br /> Seepage Pit: Distance to nearest well______ ...............Distance from foundation_________________-. istance to nearest lot line_______._______- <br /> ! <br /> ine----------------- <br /> -1 Number of pits----------------------Lining material-----_-------------.--.Size: Diameter----I------------.- _Depth---- ------- ------------------- <br /> E <br /> Cesspool: Distance from nearest well________________ Distance from foundation_..._________-__---lining material----------------------------------------- <br /> f <br /> JID 0i, C <br /> 171 Size: Diameter--- ----------------------------------Depth--------------------------------- -----------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well.___--------------------------------------------Dist,3 rnce—yrom nea st building------------------------------------------I' <br /> 1771 Distance to nearest lot line------------ -------------------------------- --------------------------------- -------------------------------------------------- --------- <br /> Remodelingand/or repairing (describe):---------------------------------------------------------------------- ----------------- ------------------------------------------------------------ <br /> -----------.............I----------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------......-------------I------------------------------------------ -------------------------------------- <br /> t_1 I V ­—ir <br /> ---------------------------------------------------------------------­-------­I----------------------------------------------------------------------­----------------------- ---- -- <br /> I hereby certify that I have prepared f his,application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Lodal Health District, <br /> L <br /> (Signed)--------- ------ <br /> ------- ---------------- - -- --- ------------- ---------------------------------(Owner and/or Confiactor) <br /> By=----.. ---------_-------------_----------------------------------------------------------- ----- •[--------------- -----(Title)------------------- i ---1-----------------------=----------------- <br /> (Plot plan, showing SiXG of lot, location of system in relation to wells, build'n is, etc..4 can be placedd on reyLrse side). <br /> j FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY---- - --- ----------------- ---------------------------------------- <br /> DATE::-:- -- <br /> REVIEWED BY------------------------------------ --- ------------------------------------------------------------------ DATE ----�----w-- <br /> - - <br /> -------------------- <br /> ----- <br /> BUILDINGPERMIT ISSUED----------- --------------------------------- -------------------------------------------------- DATE..--.--- ---------------------------------------------------- <br /> Alterationsand/or recommendations------------------ ---------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------- ---------- ----------------------------------------------------- ---------------------------------------------------------------- -----•-------•-•-----•------------------------------- <br /> ---------------------------------------- <br /> --------------------I------------------------------- <br /> ----------------------------------------1_____1------ -------------------------------------------- ----------------------------------------------------------------------------------------- -------------------------------- <br /> --------------------------------------------------------------- ------ ----------------------------------------------------------------------- --------------------------------------------------------------------------- <br /> A, -------- ----------------- ------------------------ <br /> FINAL INSPECTION BY-------------- <br /> Date <br /> ---------------- <br /> SAN JOAQUIN LOdkH' EALTH-DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Loci California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />