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\V <br /> APPLICATION FOR SANITATION PERMIT Permit No.ly ��-.•- <br /> (Complete in Duplicate) <br /> Date Issued -- a-� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-------------- <br /> I <br /> Owner's Name - ----—;/ YvrJ---- -- --------•----------- --------------- _ ------U--- Phone. <br /> Address---- <br /> Pkone- <br /> Contractor's Name----------•- --•-------------- --G'G -----�`-��'"��'------------------------------------------ ------ G_9�d <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .-/.--,Number of bedrooms _R_. Number of baths __1--- Lot size _____ 2--- - _- <br /> Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table, Y�� ft. <br /> Character-of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 2--New Construction: .Yes ❑ No E[-"EHA/VA: Yes ❑ No Q�— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted-if public sewer is available within 200 feet.) <br /> ptic Tank: Distance from nearest welf------__------_Distance from foundation-------------------.Material-__---.---____.-----__------ <br /> No. of compartments------- ------------------Size-----------------------•--------Liquid depth-------------------------.Capacity----------------------- <br /> D•spcsal ield: Distance from nearest well....... -----Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Number of lines----- --------- .- --_ <br /> '�`�-••� __-_--Length of each line------------------------------Width of french <br /> Type of filter material------------------ ----Depth of filter ma#erial-----------------------Total length-------------------------- -.------------- <br /> Seepage Pit. Distance to nearest well---- Q--- <br /> --------Distance•from foundation__-- --------�� Distance to nearest lot line-_---`S�__-- <br /> Number of pits---_`_----.------Lining material-_r� __,Size: Diameter-------3-.'�..."'._-_Depth_-- ---------------------- <br /> Cesspool: <br /> --_--- <br /> El ---Size, Diameter------ -----------------------------------Depth,-------------------------------- ----------------- Lining material----------------------------- <br /> --- <br /> p - , . ----- - � ------Liquid Capacity----------------------- <br /> ess oo : istance rom nearest well-----------------Distance from foondaEon. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building <br /> ❑ Distance to nearest-lot lines -~ ___ ___________ <br /> ------------------------------ ----------= ----------- - <br /> ---------- <br /> � r - - <br /> Remodeling and/or repairing. (clescribe):------i-------------------------------------------------------------------------------------•- <br /> ------------•------ ----------- --------------------------------------------------------------- -------------------------------------------------------------- <br /> -------- --------•-----------------------------------------•-------------- ---------------------------••----------------------•----------••-----------=-- <br /> ------------- -------------- ------ ------------------------••-----------------------••--------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat A" s, and rules and regulations of the San.Joaquin Local Health District. <br /> i <br /> (Signed}_ r <br /> ---- --- - Contractor) <br /> _-__.1Ow er and/or <br /> r ..----- -------------------- -------------------- <br /> BY: -f f---- - ----(Title)-------lle�--- -------•--------------------=--------- <br /> (Plot plan, showing size of lot, location of system in.relafio to wells, buildings, etc., can be placed on reverse side). <br /> T <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------- ----- ----- ------- ----------------•--------------------------- DATE-.-- . <br /> REVIEWED BY --- DATE <br /> BUILDING PERMIT ISSUED------------------------------ -- --- DATE-------- <br /> Alterations and/or recommendations:-------------_- ---- --- , <br /> ` , <br /> �.4` -_ ---------- <br /> --------------- --- ------ <br /> ...-- i:----r'-------------------- ----- ----------------------------•------------- - V <br /> ----------- <br /> ------------------------- m � - -------- <br /> - - ----------- -----------------------------------•------ ------•----- <br /> ---- ---- -- <br /> --------------------­--------------------------------------- <br /> ------------------------------------------ - <br /> FINAL INSPECTION BY: r <br /> ---1 Daae <br /> �� .. i.� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 4 <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, Californla Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revisea 1.57 F.P.CO. <br /> f <br />