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APPLICATION FOR SANITATION PERMIT Permit No. _-6 - _----- <br /> (Complete in Duplicate) a <br /> Date Issued-=-ia./?'_ � S' <br /> ApplicaFion is hereby made to the San Joaquin Local Health District for .permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordin nce No. 549. <br /> 3 � - <br /> JOB ADDRESS AND A ION----- - ----- _-. l .� -� - <br /> == <br /> ------- -- --------------------- <br /> Owner's Name----- .. Cr - --- ------------- ----------- Phone-------- <br /> Address <br /> ! l�a <br /> 01 <br /> Address---- ----------------------- - <br /> Contractor's Name ---------------------- --- -------------------------------------- ------------------ Phon ---------- - <br /> Installation will serve: Residence Apartment-House,❑ Commercial-E] Trailer'Court ❑ Motel ❑ Other ❑ s. <br /> Number of living units: -3- Number of bedrooms - . Number of baths _e___ Lot size _-_ _ y ----_---_-_------------- <br /> Wafer Supply: "PublicusystemK iCommunity system ❑ Private ❑ Depth to Water Table/ ft. <br /> Character of soil fo a;depi li of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ AdobA1V Hardpan ❑ - <br /> Previous Application Made: Yes ❑ No New Construction: Ye No E] , <br /> F' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> ,(No septic Tank'or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest well-----------------Distance from foundation_.---___--_----____.Material <br /> _---------___.-_----_.__--_-------._-----_---. <br /> P --------------------------Size-----•----------------=---------Liquid depth.-------------------------Capacity---- ----- <br /> f No..of.com"compartments <br /> Dispos eld: Distance-from nearest well Distance from foundation------------------`Distance to nearest lot line-----__.--_------ <br /> Number`of lines--------------------- -------------Length of each line------------------------------Width of trench----------------------------------- <br /> See a e Pit: Ripen f filter material-----------------'--------Depth of filter material------------_--- Tot�I lenyfh--------------------------------_------:-- <br /> T e o <br /> �.. ..-,.._ � <br /> g ce to nearest wellr2 -_-__Distance fr m fo dation_--- -_ Distance to nearest lot line_--- .--___ <br /> Number of its--- - Linin material- Size:"D- meter----- -----------------Depth____ <br /> P � ; 9A . <br /> Cessp?ol:� Distance from nearest well-----------------Disfanco from foundation__-.-...------.._e Lining material--.--__------ -------_____--. , <br /> ❑ Sizo: Diameter----------------------------- ------Depth------------------------=------------_--=----------Liquid'Capacity, 'gals. <br /> Di"' <br /> —ill ,-. <br /> Privy:s Distance from nearest well--------------------------_-__-___.-___---------Distance from nearest building_ _-_____-------,•------------- <br /> ❑ 'Distance to'nearest lot line --- <br /> € ------- ------------------------------------------- - <br /> Remodeli and/or repairing°(describe):__ -_ ----- �"� -� <br /> ` = n;` <br /> ------------- --...: --------- ----- <br /> -- ----------- <br /> �`�. —— --- ------------------ n ---------------•----------------------•---- . <br /> _ -------=---------- ..-,fz --`_ <br /> 1 --•------------------- ------------------------------•----- ------ . <br /> I hereby certif that I have prepared this application and-that the work`will be done in accordance with San Joaquin County <br /> ordinances, State laws rules and regulations of the San Joaquin Local 1=lealthADistrict. - C <br /> r <br /> (Signed) - - ----- ---------------------- -------------- ---- -'� � --(OwnerO- - d - ' �x i <br /> , ._-_- and/or ntractor) <br /> `By=--- -----------• -(Title) �ee <br /> ' <br /> --------------- ---------------- <br /> (Plot plan" showing si of lot, 1 cation of system in relation to wells, buildings, etc., can be pl e oide). <br /> T FOR DEPARTMENT USE,ONLY <br /> APPLICATION ACCEPTED BY---------- = DATE ��- <br /> ---------- ------------------------------- DATE <br /> BY-------------------------------------- b DATE l� . - - • . ..n : <br /> BUILDING PERMIT ISSUED--------------- ------- <br /> -------------------- <br /> ----- ------------------------- <br /> ---- <br /> - - <br /> Alterations and/or recommendations:--___------------ - <br /> -- - ---------- _ <br /> i �� + ---- ---------------- <br /> --------------- <br /> ---- --- --- <br /> r� ------­--------------­--•----------- ;� - - ------------------------------------------------------------------------------------- <br /> FINALINSPECTION BY:-"""e�7 = F Date.---- <br /> ------------------ --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street t, 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> [ { Stockion, California Lodi, California Manteca, California Tracy, California <br /> "e <br /> ES-9-2M . Revised W=2100' <br />