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APPLICATION FOR SANITATION PERMIT Permit NA-'_!6V�_3 <br /> (Complete in Duplicate) Date Issued -9--- <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. ti ,e <br /> , Al <br /> f a ' _ -------------- r. <br /> JOS ADDRESS AND LOCATION________ __ <br /> Owner's Name __ _ -------------- ------ Phone.---- ------------------------------- <br /> Address-------------------- <br /> ------ ---------------------- <br /> Address-------------------- <br /> y -------------------------------- <br /> Contractor's Name _ '1__ .._.4 / ' i...------------------------------------ Phone--'F- -- <br /> Installation will serve: Residence Apartmouse mmercial ❑ Trailer Court ❑ Motel [] Other ❑ <br /> Number of living units: _ _--- Number or <br /> of b fro s .-.----- umber of baths .__! Lot size <br /> Water Supply: Public system ❑ Community system rivate 54 Depth to Water Table ft. <br /> Character of soil to a depth' <br /> if 3 feet: Sand E] Gravel E] Sandy Loam F] Clay Loam ❑ Clay El Adobe j� Hardpan E]Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ` x <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ,Septic Tank: Distance from nearest well-----------------Distance from foundation------------------.Material <br /> ❑ No. of compartments-------__--------------Size--------•-----------------------Liquid depth------ CapacitY ` <br /> Disposal Field: Distance from nearest welL��___-_Distance from foundation <br /> Number <br /> to nearest lot li`,&----0 � <br /> .. <br /> Number of lines-... L./ _---_-_-Length of each line._...7'17______ -- Width of trench.-- <br /> Type of filter material__ -- kt K.,Depth of filter material-_._.__. Total length/� --------------------------- <br /> Seepage Pit: Distance.to nearest well..--------------------Distance from foundation.__------__-...__-.D;sfance to nearest lot line------_--_.._____ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------------Depth--------------------------------- <br /> Cesspool: <br /> ----- --------- --- ------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-------_.---- -___---_--._-- <br /> El <br /> Size: Diameter--------------------------------------Depth-------------------------------------------- -------Liquid Capacity-- -------------------- --gals. <br /> Privy: Distance from nearest well---------------------- _--_------__Distance from nearest building--------------- <br /> ❑ Distance to nearest lot line________.-_____ <br /> Remodeling and/or repairing (describe):------ ---- A � ----------- <br /> f- -- - - - --- -- - -- <br /> --------------- -------------------- --------------------------- --------------------•-----•---------•-------- •-------•--- - - ---- - <br /> ------------------------------------------------------------------------------------------------------­ ----7----- <br /> --------- r. <br /> ------------------------------------------------------------------- •----------------------------------- <br /> 1 hereby certify that I have-peep this application and That the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, all-rul and gulations of the San Joaquin Local Health District. <br /> {Signed} rT I_�_1_ -- ---- �- rL---- ---- --- {Owner and/ r Co t� cfor) <br /> � � e <br /> BY: k -- C, (Title} <br /> - ------------------------- <br /> - - ---- ------ <br /> ot plan, showing size of lot, location of system in relation to wells, uildings, etc.,,can be place on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------- -----ei'-------- _ 'r:=- ------------ DATE-. <br /> REVIEWED BYDATE z f <br /> BUILDING PERMIT ISSUED �:. DATE - -- ``--�-- --- <br /> Alterations and/or recommendations--------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------ <br /> --•-------------------------------- " <br /> ----- - ---------------------- <br /> _----,---r-----------•----• <br /> ----------------------_------------•------------------------....-----------.-_.-.--_-.-------------. <br /> ----------------------------- .� <br /> �f <br /> FINAL INSPECTION BY:-------- l J � flL'--- -- ---------- Date_------------� ��I'll- -- 5 --. <br /> _ SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 5oufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi. California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 P <br />