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-------------- <br /> ...... <br /> APPLICATION FOR SANITATION -PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> 4" <br /> Applica-%n 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 compliancewith County OrdinanSe No. 549. <br /> v�----------- -----R1--------I------- <br /> JOB ADDRESS ANPOCATIOISIIP�l .�_r/vvt t <br /> 4 <br /> Pho ---J---ZYk_7....... <br /> Owner's Name--------- ------- <br /> Addres -------_-------3 Y 7,rr" --- -- -------- ------ --- --------- --------------------------------- -------------------------- <br /> s..... ------- ------ ---- <br /> --------Phon ..... <br /> Contractor's Name_-______-;_---------- ---------------- - -- ---------------------------------------------------------------------------- <br /> k Motel 0 Other 0 <br /> Installation will serve: ,'Residence [Apartment House El Commercial L] Trailer Court 0 <br /> Number of Iivli_ng.�units:-`__p -N- umber of bedrooms .-4- Number of baths Lot size --------------- <br /> Water Supply: ".Public.-i,ysfem']­� Community system E] Private Ur"Depth to Water Table ft. <br /> .I� 1-1 .g, E] ff'-' <br /> Character of soil to i"depfh of 3 feet: Sand E] Gravel El Sa.nd y Lo;; Clay Loam Clay El Adobe Hardpan ❑j <br /> Previous. PIP A 'licafio;�Made- Yes 0 No [21New Construction: Yes N 0 El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No sepfic'fank,or cesspool permitted if public sewer is available within 200 feet.) <br /> founclation_ <br /> Sept Distance from nearest well___ d____---- - ------------ <br /> i6 ank: Distance from <br /> a <br /> -No. of compartmen'ts-------A--------------Sli,e477_'Y _*_X_A"_1iquid -------------C pacify_)A,q_d-------- <br /> 'r : nearest lot line---- ....... <br /> J'74_ -------- <br /> --- Distance to <br /> Disposal Field: ,Distance from nearest well - - ------------Distance from foundation-----/. . <br /> ..........Width of french----;AAOt!.............. <br /> V. ­­ 'f <br /> Number of lines--------- ofreach line------15A 0- <br /> ------------Toital� length_____/1j"_1---1�7-------- <br /> Type of filter material__1_;P_`____ ----Depth of filter material p __0 <br /> Seepage Pit:—' Distance to nearest well-----------------------Distance from foundation-------------%------ a nearest lot'line-------I---------- <br /> ❑ I material-----------------------Size: Diameter- ' - <br /> Nurrl'66r of pits------- --------------Lining ---------------- - -- <br /> _u6pth-------------------------------- <br /> ,Cesspool: Distance from nearest well-----------------Distance from foundation...I---- -----------Lining material-_-__________._________-__________. <br /> ❑ Size: Diameter------------ -------------- -----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----------------------------------------------Distance from nearest building_________.____-_____________-_---____-_. <br /> ❑ Distance <br /> uilding------------------------------------------ <br /> Disfanceto-nearest lot.line------ -------------------------- ----------------------------------------------------------------------------------------------------------- <br /> Rem`bd6ling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------m-------------------------------------- <br /> ------------------------ <br /> ---------------------------- <br /> -------------- ------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------- <br /> this application +hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signf0fter and/or Contractor) <br /> ed)------------ --- ------------ --------- --------------------------------------------------------------------------- - ------ I <br /> -- --------------------------------------------- ---------------- -- -------- ----------------------------- <br /> By:..........�__ -'(�1111 ----------------------[Title)--- -------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__�----- ----------------------------------------------- <br /> ' REVIEWED BY------ ------------------------- -- <br /> ------------------------------------------ DATE------- -------------------------------------------------- <br /> BUILDING PERMIT ISSUED--------------------- - DATE..----------•---------------------------------------------- <br /> ------------------------------ <br /> Alterations and/or recommendafions:. _.—,-'.-..-"---�I--- •---------- -- <br /> -------:7 ----------------------------------------------------------------------------- <br /> - ----------7---------- <br /> uY <br /> -------------------------------4-------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------I-------------------------------------------------------*-----------------------------------------------*--------------------------------------------------------- <br /> -------------------------------- ------------ <br /> -------- -------------- <br /> Z---­----------1_____1------------------------------------------------------------------------------------------------------------------------------I--------------------------------------------------------------- <br /> ------------------------------------------------------------------------ <br /> -------------------------------------------------------------- -------------------------------------------------------------------- <br /> 7t <br /> Dafem��—-------------------- ---------------------------------------- <br /> .'A <br /> :---------- <br /> FINAL INSPECTION `BY: <br /> k <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak'S free+ 132 Sycamore Street 814 North "C" Street <br /> Stockton California Lodi, CaFlif&"*S. Manteca. California Tracy. California <br /> ES-9-2M Revised W-210D <br />