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APPLICATION FOR SANITATION`f �� aa��PERMIT Permit No. C?S. _ ----I QQ <br /> y (Complete in Duplicate) s`b <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Heaith District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance N . 549. <br /> JOB ADDRESS LOCATI - ------- <br /> ''` <br /> Owner s Name____-- _ -- <br /> Phone__`t'__=__f_- -1 ----- <br /> C <br /> Address- I �J- -------------------- ---------------•-------------------------------------------- <br /> Contractor's Name-- ------------------------- ------------------------- ------------------- Phone------------------------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Mot!; ❑ Other [Iaa "'f <br /> Number of living units: _Z__ Number of bedrooms .tit-- Number of baths Z__ Lot size __---f` .4F---&tOZO--r <br /> ---------------------- <br /> Water Supply: Public system 36 Community system ❑ Private ❑ •Depth to Water Table _______ ft. <br /> Character of soil to a depth of 3 feet:. Sand Q .Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ AdobeHardpan ❑ <br /> Previous Application Made: Yes ❑ No V New Construction: Yes LYJ No ❑ i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No,septic tank or cesspool permitted if publiclsewer is available within 200 f/eet.)t ' <br /> Septic ank: Distance from nearest well- __ ____ Distance�'om fou tion_!_ Mat ripl______-----_----------- ___ <br /> _ 5ize10__'_ .-x--------Li uid[�d th__ __°T_ -Ca Capacity <br /> Iy No. of compartments---------- j G p p Y ' =�•. <br /> Dispos 1 Field: Distance from nearest well__��_-_0-----Distance from foundation_��bistance to nearest lot line-1 •-------- <br /> Number of lines___________ _ �, ___�_ epth <br /> Length of each line__- _______ f{----Width of trench______ -7V �________________ <br /> Total len th I -------------- <br /> ¢- <br /> Type of filter mate ri of filter material_______1-(,�__ g <br /> Seepage -Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to:nearest lot line----------------- <br /> ❑ Number of pits----------------------Lining material----------------.------Size: Diameter------------------------Depth_- •---------.----------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining <br /> . . . material___-______-______________-___--______- <br /> ❑ Size: Diameter------------------:-----------------;-Depth__^;=--.,---------_:------- ------�_:----Liqud -Capa -city- I <br /> gals, <br /> Privy: Distance from nearest well--------------------------------------I- _ ----_-Distance from nearest building----.--------------------------- <br /> ___..__... <br /> ❑ Distance to nearest lot line---------- ---------------------------------------------------------------- <br /> Remodel.ing and/or repairing (describe):------- -------------------------------------------------•-----------------------------------•-------------------------•------------•------------------ <br /> ------•-------------------------------------------------------- <br /> --------------------------------------------------------------••-----•--------------------------------------------------------------•--•---•-----------------•------------------- <br /> -------•---------------------------------------------------------------------------------•----------------------------- --------=----------------------------------------------------------•------------------- <br /> hereby certify that I have prepared a plication and-tbat the work will be done in accordance with San Joaquin County <br /> ordi nces, State laws, and rules and r u of s of th an J4quin Local Health District. <br /> (Signed)---- --- ------------ --- - --- --------- - --------------------------------------- Owner and/or Contractor=------------ --------( <br /> Y- <br /> 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 /> APPLICATIONACCEPTED BY-<] ----------------------- --------- ---------------------------------------- DATE- ------------------------------------------------ <br /> REVIEWED BY---------------------------- <br /> ------ DATE--------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------- --------------------------------------- DATE----------- <br /> Alterations and/or recommendatiions----------------------------------------------------------------------------------------------------------------- <br /> A •�" -------------- -•�` <br /> _ •��, r - ---------------------------------------------------------- ---------------------------------------------------------------------------- ,.., <br /> ---------------- -- -------------------------------------------------------------------------- ---------------------------------------------------------------------- <br /> ------------------------------------------------------ ----- ----------------------------------------------------------------------------------- -------------------------------------------- ---------- <br /> 117 <br /> FINALFINAL Date_ ---------- <br /> INSPECTION BY---- ------------ --------------------�--- ----------- --- -- - -- --------- -------------------:--=------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca. California Tracy. California <br /> E5-9-2M 8-51 Revised W-2100 <br />