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--eAPPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Application is hereby ma' 14'0 LLZ �Jl Date Issued <br /> cle t -the San'- oaquin Local Health District fora permit fo con 2- — (q 0 —1 2----- ---- ----- <br /> This appiicafjorj is made in co Joaquin, 2-1 ---- -- <br /> ompliance with County Ord' construct and install the work <br /> 11 n <br /> 9,ne No. 549. herein described. <br /> ,A <br /> JOB ADDRESS AI I , <br /> OCATION044gell <br /> --------- - <br /> Owner's Nam ' .--- ---- ---- ---- -- --------- <br /> - <br /> -- - ----- --------------- ------------------------------- ------ <br /> Address----- ------- --- ------- --------------------- ------- -------- Phone <br /> ---- --------------- - ------------------------------------------------------------------------------------------------ <br /> Contractor's Name------------------ -- •-------- ---- ----------------------------------------------- ---------------------------------------------------- Phone-­ <br /> Installation will serve: Residence E� Ap menf House E] Commercial E3 Trailer Court 0 Motel 0 Ot.her---------------------- <br /> Number of living units: --------lNumber of bedrooms -------- Number ❑ <br /> of baths <br /> Water Supply: Public system 0 � -------- Lot size ----------I------------ .. ....... <br /> Community system [3 Private Depth to Water Table'­4/"�-- <br /> Character of soil to a depth of 3 feet: Sand 0 x -Atol— <br /> Gravel Ej Sandy Loam El Clay Loam 0 Clay [D ecl-�- Hardpan E] <br /> Previous Application Made: Yes El ❑No New Construction: Yes Kf No E] FHA/VA: Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:N dobe <br /> (No septic tank Or'cessPool permitted if publ <br /> Sic se er is available within 200 feet.) <br /> ep 'c ank: Distance from nearest well--'% '0 <br /> I -;Wzv------ istance from-foun <br /> No. of compartments------0 ?1' n--- -------Ma <br /> f ial-2 <br /> Disposal Field: -—------ ----Size/;U- a-y - I q-* <br /> D q depth______Distance from near -------- ---- <br /> r t F- ­2�,e-­ apacity <br /> s well <br /> Number of lines 7--&-47tbistance from founclation­�U--------Distance to nearest lot ine <br /> ------- - Length of each <br /> ------Depth of filter material---4L-j-- trench-- -_of filter mate 1. <br /> riaJ T! Width of fren <br /> ofaf length------ <br /> Seepage Pit: Distance to nearest well-______-- Distance from foundation-------------------.Distance 1�- to nearest lot line <br /> F1 Number of pits-----------------------Lining material-----------------------Size: Diameter <br /> Cesspool: Distance from Diameter------------------------Depth--.-__--_--_ <br /> nearest well--_______--_._--Distance from foundation- ---------------Lining material--- <br /> ❑ Size: Diameter- ----Depth-. <br /> Privy. -.._•..-- -.� -- -- —------------------------------- ---------- <br /> 't I - ------------------------Liquid Capacity ------------ <br /> Disfance from nearest ------------------ 15. <br /> wel -----9�afs. <br /> 9�afs. <br /> —9 <br /> e ---------------------Distance from nearest building-7 <br /> El q an Distance to nearest lot line__ --------------------------- - ------- ------------------------------- <br /> Remodelin. and e ---------------------------------- "----------------- <br /> -- 4-Vr*0—----- I------ -1 ------- --- <br /> ----------------------------------------- -----/---- .... .. <br /> ------------FA ----------------------------- -- ---------------- 9) <br /> - <br /> --------------------------------------------------------------- ---------I------------I------------------------------------------------- <br /> ared this application and that the work will be done in accordance with-San--J-o-a-qu-in--C-Count <br /> -y- <br /> ordinances, State lawsd rules and regulations of the San Joaquin Local H e a It h--Dist-ric-f-------------------*------------ <br /> I hereby certify that I have prepared ----------------------------- <br /> (Si -- -------- <br /> --- ---- ---- -I--- - --- ---------- <br /> -------- _-___(Owner and/or Contractor) <br /> -------------I----------------------------------------S-------------------------------------- <br /> w ----------------------------(Title)----------------------------------- <br /> Of Pla showing size of lot, lo�afion �f system in relation to wells, buildings, efc., can be placed on reverse side---------------------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-... ( - <br /> ---- ------------------ ------------------------------------------------------------------- DATE <br /> ------ ---- -- --- --------- DATE - - ------------ <br /> BUILDING PERMIT ISSUED,--------------- -------- DATE <br /> ------------- ------------------------ --------- <br /> Afferations and/or recommendations:--- <br /> ----------------e-,2­-,,1Z -------------------------------------- ------------------------------------------ <br /> -------------- <br /> to <br /> -z-------- ---------- ------------------------ <br /> -------------- ----------- <br /> - ----- --- ------ <br /> ---------------------------------------- ------------------------------- <br /> --- ----- -- -- ----- ------------ ------------- <br /> --------- <br /> ------------ -- <br /> -- -------------------------------------------------------- ------------ ------- --------------- <br /> ------------------ <br /> ---------- -------------------------------------- ---------------- <br /> -------------- <br /> FINAL INSPECTION BY.,______________ ------------------------ -------------- Date <br /> -------- <br /> v0 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 We.st Oak Street <br /> Stockton, California 13.2 Sycamore Street 814 North "C" Street <br /> ES-9-2M Reviseci 7.57 F.P.Co. Lodi, California Manteca, California Tracy, California <br />