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44\N\' .� <br /> ` APPLICATION FOR SANITATION PER_vl1T Permit No. <br /> 4ZA (Complete in Duplicate) j/ _S <br /> Date Issued ___`�J .�___ <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 LOCATIO --- - <br /> -------------------- ----• <br /> Owner's Name- _t-2J- ®- •... -------- -•------------•-"-•------- ---- - ----------------------- -------------- Phone---------------------.......... <br /> Address...IZ-=1---L-9-----------6�_ .. `.� <br /> Contractor's. Name---QLc?-Li?----��- --- --------------- t 4y_.z - ^------ <br /> Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ Number of bedrooms __2—. Number of baths I----- Lot size .____>�---.1�___/__.�" ---------------------- <br /> Water <br /> __________________ <br /> �� �. <br /> Water Supply: Public�sysfem ❑ Community system ❑ Private-2--Depth to Water Table- f+. _- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ <br /> Previous Application Made: Yes ❑ No "New Construction: Yes ❑ No <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 ------------Distance from foundation-------------------Material_----_"-___-.----_--_--.-_.__---_____"___--_---. <br /> No. of compartments---------- -------'--Size--------------------"-----------Liquid-depth--------------------------Capacify----------------------- <br /> isposal Field: Distance from nearest well-------y--------:Distance from foundation--------------------Distance to nearest lot line___-.____-----_-_ <br /> Number of lines-----------------------------------Length of each line-------------------------------Width of trench-------------.--•------------------ <br /> Tyke of filter material--------------- ---------Depth of filter material-----------------------Total length__-_._------_"--__-..-_------_---_.-_--- <br /> ;,SeepagefPit: Distan e to nearest well_-_LG'a' _`_---Distance from �fo��undation_____12...___.Dis+ante to nearest lot line----J- 1-----_-__- <br /> Number of pits--------,�___-------"Lining material-- --- --.Size: Diameter--- -<�"-.-"- Depth-----Xq`°l_________________ <br /> Cesspool: Distance from nearest well--_-----__-__._°Distance from foundation--------------------Lining <br /> d material__---------------------"-�}_-__._- <br /> Size: Diameter -------------- ----------Depth---"------"•----------------------------------- Li Liquid Capacity-------------:--------------gals. <br /> � <br /> Privy:} Distance from nearest well-----------------------------------------------Distance from nearest building-_--__"."______-___----____---"__---.___. <br /> ❑ Distance•to nearest lot 6e----------------------- \n <br /> < < Remodeling and/or repairing.(describe)--------------------------- ------------------------- ------------------------------••------------------------------- ---------------------------- <br /> - <br /> ------------------------------------------------------------••----------"-----------"-------- ---------•------•-•-------------------------------•--------------......------------------------------------ { <br /> I <br /> -----------------------------"--_-__.__----_-"-_------_-___----____----...._____-_-_---____---_-_-_--__-".-__-._---. ---.-_____-_----__-__"-.-_--_-__----___-..------__-_-_-----""___-_--____-.__---.-_-----t.._.---------------- <br /> I 1 hereby certify Ghat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,lState laws,"and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) L- <br /> - a Contractor)---------------- <br /> - --=-------------------------------------- -------- <br /> By:....... - ------{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 y <br /> APPLICATION ACCEPTED BY--------------- - - DATE <br /> REVIEWED BY ----------------------------------------=--•------- DATE---- - ----- <br /> BUILDING PERMIT ISSUED - ------ DATE - ----- -------- - - --------------------- <br /> S: <br /> --------------------- <br /> Alterations and/or recommendations: <br /> ---•-•-•-------------------------- --------------------•-------•-----------------------•-------------------------------•-•--------------------------- •--•--------------••------------•-------------•---------- <br /> -------•-•-----•------ ----------------------------------- --------------------•---•----------------------- -•----------------------•------------------- ------•­-------------------------------------- <br /> t i — Ll Si— <br /> FINAL INSPECTION BY---- ------------------------------------------------------------ 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 W-2100 <br />