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V/. <br /> 1 APPLICATION FOR SANITATION PERMIT Permit No.(Complete in in Duplicate) <br /> Date Issued _-- _?'----- --, - <br /> plication 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 LOCATION---------1-s7zQ------4-'4£x- <br /> Owner's Name----------------•-------------------------L A-a-fe--y-----------4 1 le7/q �-------------- ----------------- Phone------------------------------- <br /> Address---------------------------------- ...-------------_n%- ------------------ ----------------------------------------------------------------------------------- ------------ <br /> •6 . <br /> Contractor's Name--------------------------------- - _�/__��2-----7 �Q <br /> "-.7-_5 Phone. ._/ -Q .--- <br /> Installation will serve: Residence Apartment House ❑ Commercial F] Trailer Court E] Motel [-] Other E] <br /> Number of living units: _,�-__ Number of bedrooms __-_ Number of baths __1_ Lot size <br /> ----f-CAP--------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .�ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No A 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.) n <br /> Septic Tank: Distance from nearest well-tko.MM__Distance from foundation_1.0_'__-____--.Material-__- ?c'�-� <br /> No. of compartments-..----Z---------------Size_Z'6") 33.4* __Liquid depth---- - -�_'--- - --Capacity--gpQ_-_.-------- <br /> i Disposal Field: Distance from nearest well__Me_t4F_Distar�e from o datjon___I_ _1_-.___..Distance to nearest lot line__ <br /> Number of lines___.j____________________________ Length of each line___ _� _ Width of french-... ___"" <br /> 1 er - g ® <br /> - <br /> Type of fil#er material---J-._�3�---j -Depth of filter material ._.------/(f.....Total <br /> Seep a e Pit: Distance to nearest well.NtL44jF_____Distance from founda+ion--3-p.........Distance to nearest lot line_-__ �. <br /> Number of pits----I________________Lining material_' 4-_size: Diameter-� "__.____Depth-__. _ -'_______--_____ <br /> Cesspool: Distance from nearest well-________________Distance from found ation__-_-_,-__----------Lining material _._______-.___-___________-__-____.-. <br /> ❑ Site: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------- ------gals. <br /> Privy: Distance from nearest yell_____________________________________ ______Distance from nearest building---------------------------------------- <br /> ElDistance to nearest lot line- ----------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodelingand/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 /> ordinanegs-Stmt laws, and rules an regulations of +he San Joaquin Local Health District. <br /> (Signed) . . -----•... Contractor) <br /> - ------------------------------------------------ ----- -- <br /> By------ -------- ------------------------------------------------ - - -----------•----- -----(Title) s -------------- <br /> (Plot plan, showing size of lot, location of system i elation to wells, iIdings, etc., can be p on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- - - -- 5 -------------------------------- DATE------------ / <br /> REVIEWED BY-------------------------------------------- ------------------------------- --------------------- -------------------------- DATE------------------------- <br /> - ------------- ----------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------------------------------- <br /> Alterations and/or recommendations:---------•------------------------------------------------------ -------------------------------------------------------------------------------------------1. <br /> --------------•-------••--•--------•-------------------•-----------•------------------------------------- ---------------------------------------------------------------------------------------------------------•--------- <br /> FINAL INSPECTION BY:------------------�II_'--r/---- ------- Date------------------0 V --------------------_=--=_ ----- <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 10-52 Revised W-2100 <br />