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t <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...... <br /> �-�. .... <br /> 42-1 1 ' (Complete in Duplicate) Date 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 No. 549. <br /> JOB ADDRESS AND LOC TION.._A _.+_� .�__aZ,. :__V_Q._._..__ _ _ <br /> - ---------------- <br /> Owner's Name---(!y .!! V "d ------ •------------ Phone......----------------------------- <br /> 0,601 <br /> Address---- f�t_�I. a, <br /> Q ,� -- -•-•------------------------------ ------------------•-- ----•--------------•-------------•- •--•--- _._---............ <br /> Contractor's Name.....'_UI' .... <br /> ---- e„e._. +� <br /> Installation will serve: Residence 4�artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of,living units: J--- Number of bedrooms -,*?- Number of baths I... Lot size ..... ................. <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table So ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe If ❑ <br /> Previous Application Made: Yes ❑ No 4—"New Construction: Yes 4►fdo ] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--------------...Distance from foundation.....10.......Mat ial-w001 _ <br /> [ No. of compartments---•-!Z...-•---------Size•..J%... !�.44-b_•_Liquid depth...V _. 't_._Capacity....V4 ...... <br /> Disposal Field: Distance from nearest well Distance from foundation -I l� <br /> P b -- <br /> Distance to nearest lot line <br /> Number of lines_.. � �'� <br /> _.�� ._.��____ _ _Length of each line---- _�� Width of trench....��:--_______. <br /> Type of filter material_1_�.___ . Depth of filter material, , _______Total length_______.'. _ . _..__.__: t <br /> Seepage Pit: Distance to nearest well ___________________Distance om fo ndation-•--347......Distance to nearest lot'line_-,�_a <br /> Number of its___. -_ _ _____Linin mate ria Diameter.... --_`_ <br /> �..-. P� �----- g -- ------Depth----�Q-----•-------------- <br /> Cesspool: Distance from nearest well•________________Distance from foundation--------------------Lining material--------_----------------............. <br /> ❑ Size: Diameter------------------ -- ----- -------Depth .--_ ----------__-__--___Liquid Capacity_ .gals. \ <br /> Privy: Distance from nearest wel---------------------------------------------.__ Distance from nearest building... __ ________-Distance to nearest lot line-------- •------• ------ -•-- -------------•--.............................. <br /> Remodeling and/or repairing (describe):. ------------- -------- <br /> .........................------------------------------------•-•--------------------•--------------------------•---- _-- ---------•--. --------- <br /> ......................................................................................................................—--------------6 <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 les and regulations f the San Joaquin L cal Health District. <br /> (Signed) --•---. --- -- '-ll �C".rC'------- 'i' ontractor) <br /> By:------- . • ..... --• ..............................................................(Title) <br /> --- - - --------------------------------- <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 DATE <br /> 7 (�--e 3 <br /> REVIEWEDBY-_------------------•-----------------------------------------------`-------------- ----------------- .......... DATE------------............................................... <br /> BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------.................. DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:_-------------------- --------------•-----------•---------------------------•--•-------•----------•---••------•-------...-•----•-••--•...•••--•............... <br /> -------------------•-------•-------------------------------•-----------------------------...-------------------------•- •--------------...-------•------•---------. ------•------•----.................................. <br /> •--------------------•••---•-•--••-----------.....•-•--•-••••---••---•--•----------------------------•----------•----------------------•---........--------•---...------•---------..._._..•--•--••----••---•-•-••---•-•- <br /> -----•---------------------- .......................................................................... -----•------------------...__.......-------------------------------•---------------------------•------------------- <br /> ----------------------------------- ------ --------•------------------•----------------------------------•-------------------------- --------•---•------------- ----------------------------------------------------- <br /> FINAL INSPECTION BY:.___.----_------ `�r����.Ta_J------------- Date.....................-------------------------------------__-------------­ <br /> SAN <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 Revised W-2f0Q <br />