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f <br /> �PPLICATIONFOR SANITATION PERMIT ,, Permit No. l_. <br /> /G 7- x� — (Complete in Duplicate) Date Issued <br /> App i ' reby 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 /> -- r Vv <br /> ---------------------------------- <br /> JOB ADDRESS AND LOCATION---------------------------------- _ ___ --------------------------------------_ _____ - -1Phone � 5 -a ----- <br /> f -- --------------------------------------------------------_--Owner s Name--------------- -----•------------- <br /> Address--------- --=------------=----------------- -- C- ----------------------------- <br /> Contractor's Name------------ - --------------- - ---------------------------------------- ----------- Phone---------------------------------- <br /> Installation wiii serve: Residence N. Apartment House ❑ Commercial E❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms __?__ Number of baths I____ Lot size __________-� X J.}'`a------------------------ <br /> Water Supply: Public system,n Community system ❑ Private [I Depth to Water Table --------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay E] Adobe Hardpan E] W <br /> Previous Appiication Made: Yes ❑ No 9 New Construction: Yes)4 No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> of compartments ,{pun �on �� Material--------- <br /> >e- <br /> t - <br /> Septic Tank: Distance from nearest well_ C�__Distance fromd`� O` -__Capacity---------- <br /> No. _-_ � -- <br /> p <br /> p 7. Size - Liquid depth--------- -- <br /> Dis os I Field: Distance from nearest well-___'___.._.Distance from foundation----� _-v�`Dis#ante to nearest lot line-------e��" <br /> Number of lines--_---------'y ------ <br /> -- --- ------Length of each line---------- -`---------Width of trench-------------�4__Y------------- <br /> �I - <br /> Type of filter material_ 0-_ epth of filter material--------- _Total length_______:`/L - __---------------- <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 material_______.__--_______-___________---__ <br /> ❑ Size: Diameter--------------------------------------Depth---------------- ------------- ----Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----_.----------------------------------------Distance from nearest building-------------------------------------------- <br /> F­ll Distance to nearest lot line------------------------------- ----------------------------------------------- --------------------------- <br /> Remodeling and/or repairing (describe)----------------------------------- -------=--------- --------------------- ----------------------------------------------------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District.. <br /> `t `----------------------)Owner and/or Contractor) <br /> (Signed) 4 -------------- --------- <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 /> DATE----------- �'�-------- <br /> APPLICATIONACCEPTED BY------------- --- -- --------------------------------------------------------------- ��--.---�jh-� -- <br /> REVIEWEDBY------------------------------------------ - ------------------ DATE------------------------------------------------------------ <br /> rBUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------- -----------------------------•------ <br /> ---------------------- <br /> Alterat'ons ar}d/or recd nda ions:------------_----�--------------------------- ---- - <br /> z -�,� <br /> . �. - ----------------------------- <br /> -------------------------- <br /> r <br /> ---- d ------------------------------------------------------------------------------------ ------------------------------------------------------------------------ <br /> `'°' --------------- <br /> - <br /> ------------ ------------ ---------------------------------- <br /> h - -,�--------------- <br /> l r <br /> .FI'NAL INSPECTION BY:_)1f - ----------- Date ! �� ----------------------------- <br /> 1 I <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 /> ES-9-2M 8-51 Revised W-2100 <br />