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A <br /> _s <br /> APPLICATION FOR SANITATION PERMIT Permit No.,J �-__•_- <br /> a <br /> (Complete in Duplicate) <br /> r Date Issued <br /> Appfica#ion is hereby made <br /> This application is mat the San Joaquin Local Health District for a permit to constr <br /> de in compliancef with County Ordinance No: 549, uct and install the work herein described. <br /> JOB ADDRESS A6.L'o,- <br /> Owner's <br /> ----•-----------=--- <br /> Name- ' <br /> ------------------------------- <br /> -------------- <br /> --- ---- --------- <br /> ------------ -------------- -- Phon _--.J ea _7 <br /> Address '. � _�-_. ---•--- <br /> ----------- <br /> ------ <br /> Contractor's Name--- ---- <br /> --------------------------------------------------------------- <br /> ------------------• - ---- <br /> will serve: Residence � - - ---- -------------------- <br /> ---- ------- ------•--•------------------- <br /> Number <br /> ----------- •-- Phone----------------------------------- <br /> Installation <br /> Apartment House ❑ Commercial ❑ Trailer Court [) otel� Other ❑ <br /> Number of living unifs: __!--- Number of bedrooms -_ <br /> -- Number o baths ---/--- Lot size -__-- _-- <br /> Water Supply: Publics stem ---0 <br /> Y. ❑ Community s tem• �- -� ------------ ---- <br /> =-~• -•----� Y Y ❑ Private "Depfhjo�Water Tdbfe•'_:--j_ ft. <br /> Character of soil to a depth of 3 feet: Sand <br /> .[D,...depth _ 0 Gravel ❑ Sandy Loam ❑ ClayLoam <br /> Previous Application Mole: Yes ❑ CIaY ❑ Adobe [' Hardpan <br /> I ❑ No New Construction: Yes [l `� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> (No s*ic'tank or cesspool permitted if blit sewer is available within 200 feet.)," <br /> Septic `ank. Distance from nearest well [I-_m' j to e fro f tr <br /> Q ration �+riate� <br /> IJ o. of compartments- -- <br /> Si e__ ,_K- _}t - <br /> .- Liquid depth . <br /> Capacifiy.- -{ <br /> Dis osal Field: <br /> "'Number <br /> nearest w 1 ` _______ a,,. - - -y----- . <br /> p istance from�;foundation.-- _ <br /> " ' - Distance to nearest lot lin _- <br /> .. z Length of each line----- ___ - <br /> ,E �> Type of filter1materi _ -_ st--'-.Width of trench---- --- i <br /> . -Depth of filter material_-_____.�_ -----Total `'tlen fh_._----_. <br /> Seepage Pif: 'A- Distance to nearest well__,-_-I- Distance from foundation to nearest lot lineEl L __. _._-_______- R <br /> Number of pits_ Linin( material------------------- <br /> Cesspool. r * Size: Diameter-- -------------------Depth <br /> { ------- <br /> ❑P f Distance from nea're±t well-----------------Distance from foundation-_-.___-_-__------.Liningimaterial____-___._.__ <br /> Size: Diameter------------ ----- 1 <br /> ------------------ -- <br /> -,_�..,, Depth Liquid I Capacity---- als. ' <br /> Privy: Distance from nearest well___ _l <br /> El Distance to nearest lot lino. resi <br /> -------------Distance from neat buildin <br /> -----� .,,�----_=.,-„ �-�--- -- - ----- 9---------------------------------- <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 /> (Signed)_.- �!-'LA -,,- 4C_(�X” ---------------------------(Owner and/or Contractor) <br /> --- ------------------------------•-------------------------------------------- <br /> (Plot plan, showing size of lot, location of system.in'relation to wells, buildin s, efc., can(beleplaced o-- reverse side-. <br /> g <br /> ------------------- <br /> ----------------- <br /> FOR'DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_. _-------.---� '` <br /> ---------------------------------------------------------------- DATE_ <br /> REVIEWED BY-------------------------------- <br /> ----- ---------1---------------------- ------ ---BUILDING - <br /> PERMIT ISSUED DATE--- <br /> ---------------------------------------------------------- -------------------- <br /> Alterations and/or recommendations—. F­----- DATE--_.._�------- <br /> ------- ----'- �. , <br /> ---------------------- <br /> -----------------------------------------J---------- -------------------- t - <br /> ------------------------------------------------------ -------- - <br /> ---------------------------------- <br /> ---------------------- -- <br /> ----- ---------•--------- -------------- •--- ----- -- <br /> ------ <br /> --------------------------------------------------------------------- <br /> ----------------- <br /> FINAL INSPECTION BY:------- _-- -- _- �,`� <br /> f <br /> /z�,p- --- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California <br /> Manteca, California 7reey, California <br /> B-9-2M 10-52 Revised W-2100 <br />