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" APPLICATION FOR SANITATION PERMIT Permit No. ... _. -------- <br /> (Complete <br /> ----(Complete in Duplicate)t pate Issued <br /> Applica+ion 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 F111o. S49. +�� <br /> JOB ADDRESS AN OCAT <br /> Phone---- <br /> Owna - <br /> r s Name-_-__-__ ! _-_-- � •-*-«-� � ' <br /> p <br /> Address..._ !�� °= - h 7 <br /> ----- -- ------- -- -- <br /> Pon --•-----�--• �� - <br /> Contractor's Name----...------•---------...------•---------• ---- - <br /> s € <br /> Installation will serve: Residences Apartment House ❑ Commerdal ❑ Trailer Court ❑ Motel ❑ Other [IT` i // Lot�size ,� <br /> .Number of bedrooms: umber of -L__-- _ll -.�- --•--- ------ <br /> Number of living units:� - Nf bat <br /> i <br /> Water Supply:- Public system� Community system ❑' Private C] Depth to Water Table __/-d.ff. <br /> h o�f 3 feet: Sand ❑ Gravel 0 Sandy Loam Clay Loam ❑ Clay F] Adobe Hardpan <br /> Character of soil to a dept ❑ <br /> Previous Application Made:] Yes M: No : New Construction: Yes 0 • Nor ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: / <br /> (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) i <br /> f - ..f, <br /> Material--•--------------.--•-- -------- <br /> tic�n�k: . Distance from nearest well.-----_---- Distance from foundation---------------- -- I <br /> No. of compartments .-Size.".!,- Liquid depth--------- 'Capacity---------------------- 'Y <br /> a ,q 1 6 / <br /> Disposal Fird- Distance from,nearest well_l � -Dist once from founda 'on-_�_6------..D`istance to nearest lot line---.--:-_-.-.---. <br /> F I Length of.each line_ &-­­!-mWidth of french....omFm- ---- --------- <br /> 5 Number.of lines__--__ -f---------- - - -- -- g <br /> •"' Type of,filter materia4_S'� -_ / <br /> Depth'of filter material--_-- _'__---Total length------------------- ------�---- <br /> Seepage .it: Distance to nearest well_ ---'Distant m f unc�etion_-_--.5 -�.:_.-..Distant Distance t6 nearest lot line_____ _______: <br /> Number of pits----/ <br /> ------ ---Lining material- .Size:Diameter-__ __�-- <br /> ....Depth...... <br /> � <br /> i• 5 <br /> Cesspool: Distance from nearestJwell-----------------Distance from foundation---.- --------------.Lining material -----__-_________----------_-_---_- ` <br /> ❑ Size: Diameter—--- r - ''' Depth ------- ---------.Liquid ,Capacity.------ -------- <br /> 7 gals. <br /> t <br /> Priv ! Distance from nearest welfr'------------------------------------ - Distance from nearest building----------------------------------------- i <br /> _ \ <br /> Distance-to-nearest;lot line-..------.-- ------ <br /> El <br /> A <br /> I <br /> Remodeling and/or repairing (describe)=-- ----------- ------- = _ -------- --:-• <br /> .. .. -- <br /> a a . <br /> I her ebq-certify M.that I have prepared this application and-.that the work will be done in accordance with San:Joaquin County <br /> ordinance , S a laws d rul regulations of the San:Joaquin Local Health District. <br /> > # <br /> ra <br /> (Signed).... 4�v <br /> -- - - : wrier and/or Contractor) , <br /> BY:.... <br /> I size of lot, location t <br /> of system in rela n to welts;'buildings, etc., can be placed on reverse side).. <br /> (Plot plan, showing <br /> R� , <br /> FOR DEPARTMENT USE ONLY . <br /> ,. <br /> APPLICATION ACCEPTED BY' -_... DATE = --. <br /> -- <br /> REVIEWED BY-----�-------=---- -•----------- ---�--------- - -- --- -- ---- -----�-- --�--�--_------ --------------•------:--;:----- <br /> DATE.---- : <br /> BUILDING PERMIT ISSUED_... . DATE........... .:..:` --------- --•------ <br /> = - <br /> Alterations and/or recommendations:: --- ----- ----- =---- <br /> --- - ------ ------ <br /> F <br /> ---------- <br /> ------ <br /> FINAL INSPECTION BY:— -;-- ---r--- -- ---� ' <br /> Date r-. _ ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT s <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street '�-7-�Z814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California racy, California <br /> ES-9-2M ; ' Revised W-2100 <br />