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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) 5 � <br /> LkILA _V_ <br /> Date Issued _______ <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 5 9. <br /> p_ �+ f� <br /> JOB ADDRESS AND LOCATION------ --- ------0.9. --------- _-, -:- --�I��►__---__ cl-�f.-�-� l_{�.�' - --------- <br /> Owner's Name --------------------------------------------------- -------------- Phone------------------------------------ <br /> Address_ <br /> ! _ <br /> ,,fi�rr �_ ._. __...-,_,....,�-�---._ .._,.y.__..-w.------•---•----------------------------------- <br /> Contractor's Name-------- ----------------- -------------- ------ Phone---------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ __ Number of bedrooms-,'?_ Number of baths Z__ Lot size Water Supply: Public system ❑ Community system Private ❑ Depth to Water TableZ­lt. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ . Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(A- ardpan ❑ N <br /> E]Previous Application Made: Yes No 8'' New Construction::.Yes RR- No E] R <br /> FHA/VA: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Vq <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well----! ---__ Distance//from foun tion-_40--- Gs <br /> ----------Material <br /> [� No, of compartments_____�------____-__Siz /d---X_ __Liquid depth-_,0�-------------Capacity-42' �-_ <br /> Disposal Field: Distance from neares well____�*-�_-_Distance from foundatio __�.N-__.__._.Distance to nearer lot line__-Qf_�____ <br /> �� Number of line s______- _____________ ength of each line_____ `________-Widh of trench_ `r <br /> _ ` ,� .,•y_--------;------------- <br /> Type of"'filter materia11-A_X�epth of Tilter material_____-/P,�____---Total length______ s> �� __ _______________ <br /> Seepage Pit: Distance to nearest well_____ <br /> --------- <br /> to nearest lot,�-ne__� ---- <br /> �J1 [ Number of pits__..__.__-___Lining material__. __P Size: Diameter--J-3--* Depth-------f----L---_______________ <br /> Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material-------------------------------------- <br /> El Size: Diameter--------------------------------------Depth----- ------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----------------------------------.-------------Distance from nearest building___________--_______-__-___________-_- <br /> ❑ Distance to nearest lot <br /> i line--�----J-�---�--o----J-------------C-1----------------- ---- <br /> ----------------•---------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe( - ��s''------ ---�--------------- <br /> --------------------------- <br /> ------------------------------------------------------------•-----------------------------------------------------------------------------------------------------•-------------------------------------------------------- <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 /> (Si ned <br /> 9 ) V-'G, Y= f ----- --(Q,m400W#e Contractor) <br /> --------------------(Title)------- --`-------------------------- <br /> (Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----TER-•0--------------------------------------------------------------------------- DATE-------J.=.20 ____ ------------------------- <br /> REVIEWEDBY-------------------------------------------- -------------------------------------•--------------------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------- ------------------------------------- <br /> Alterations and/or recommendations---------------------------------------- ----- ----------------------------------------------------------------------------------------------------- <br /> ` .--------P---�-.....IPE P..T 5------------0,-9-�-------------�-Zo sq----------T-.R_.Q..1.--------- ------------- <br /> � - - - ---- -------I--- ------- - <br /> ------ - ---------- - - <br /> ---------------- - - ---- 1005.1----` -- c�-l----- --1- ► � -- -------------'------------------- <br /> ------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTI BY:---- -- ------- ------ --InLn Date------- <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 1.57 F.P.CO. <br />