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W • - 444 <br /> 3,3 <br /> r € ' APPLICATION FOR SANITATION PERMIT ' ermit N _----- - - `f. <br /> (Complete in Duplicate) <br /> rt D��eSlssued 97).t. �f�-. <br /> ;,fir-x`� 'stall <br /> f <br /> Application is he ' y made to the San Joaquin Local Health Disfirict 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--- , -- '���7'r-..----- f ---r� r ---- -----Std_Al-✓J-----lf' i _ _ AY.y� , <br /> Owner's Name---------------------- ------------------------------------------------ --------------------- -------- ------------- Phone_--------.? 'r� <br /> Address........................................•----------------------------------------------------------------------------------•--- <br /> ----------------------------------------------------------------------- <br /> Contractor's Name--------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence LK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms _a_- Number of baths ----1!--- Lot size ------5-0--_--__�_----/Sp...*-e-.--.--_.__ <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'[rNo New'Construction: Yes No E]TYPE OF INSTALLATION AND rSPECIFICATIONS: :. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) <br /> i <br /> Septic Tank: Distance from nearest well----MW---Distance from foundation------LLI--- <br /> --- <br /> Material--------- 2 -------- <br /> No. of compartments-----------a------------Size----- -tr ± --Liquid depth---------41;. --------Capacity-------k!�'42_ _�QZO <br /> Disposal Field: Distance from nearest well......J_.......Distance from foundation---_-- ...__...Distance to nearest lot line-----j3_..------- I <br /> �] Number o.1 lines----j----------. ------------Length of each line----.°8'O_-' i.'1_ _..Width of french--- _��----------------. <br /> Type of filter material_=_--_1_y,<'--_________Depth of filter material---------1_�"_ -__--Total length-_-___._1__?0_j------------------ <br /> Seepage Pit: Distance to nearest well-----.---------- <br /> Distance from foundation-__.-.-.___--.._--.Distance to nearest lot line----------------- <br /> ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------.Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material--_.___--.__-------.---_-_----------. <br /> ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy:, Distance from nearest weft_-,-----------------------------------------------Distance from nearest building-__.-----_-___.____-_--------_ <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------- ----- <br /> Remodelingand/or repairing {describe):------------------------------ -------------------- --------------------------------------------------------------------------------- <br /> ------------ ------------•---------- � <br /> i <br /> -._---_ ._ .. -_-_ _--._--. ._ ------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I havp prepared this application and'that the work wiVbe done in accordance with San Joaquin County <br /> ordinances, S to laws, d ru s and regulations of the San Joaquin Local Health District. <br /> (Signed)-------- ------ ------------------------------------------------------------------------------ --------- --------'-------{Owner and/or Contractor) <br /> By----- --- --------------------------------------------------------------------------- ------ ---------- -----------------------(Title).-------------------------- ----- <br /> (Plot plan, sh ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> S <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE ------------- - <br /> REVIEWEDBY-------------------------------------------- ---- -------------------------------------------------------------------------- DATE------------ <br /> BUILDING PERMIT ISSUED--------------------------------------------- •---------•----------- DATE.--- <br /> --------------------- <br /> ---------------------------------- <br /> Al+erations and/or recommendations--- ------------------------------------------------------------------------------------•----------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------ ----------------•---------------- <br /> ---------------------------------------------------- ---------------------------------------------=-------- --------------------------------------- --------------------- ------- •------------------------------------------ <br /> FINAL INSPECTION 'BY:-- '-------- ----------- --- ------------------------- Date-- __qA -Az------------- --------------------- <br /> SAN <br /> Az------------- <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 />