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1 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...... <br /> .1. .__.. <br /> (Complete in Duplicate) <br /> Date Issued __________ <br /> C>s[ _(OD_112—g <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 compliangowith Count Ordinance No. 549. <br /> �. 3 �` � <br /> ­�------------W1._ <br /> JOB ADbRESS A D OCATfON_. __ <br /> Owner's Na a---- --- - ------- ---------------------------- ----t------- -- ------ Phone------------------------------------ <br /> Address. tl --------- -- -------------------------------- <br /> -- <br /> � 1Contractor's Name---- - ---•- •-------------- ----- ------ ----- ----- --------- -------------- Phone - --...----� <br /> Installation will serve: Residenceg�_-Kpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __Number of bedrooms -----?__.Number of baths 2_�LOt size -,�___.�_____--1-1 __p_________________ <br /> Water Supply: Public systemommunity system Private ❑ Depth to Water Table..�5^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 [?f,_--M-&w Construction: Yes ❑ No <br /> i7PE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) J <br /> Septic Tank: Distance from nearest wellG1 <br /> _ ______________Distance from foundation____.______._.-_.__Material____._______.__.____________________-------_----- <br /> No. of compartments_.-_._...................Size--------------------------------Liquid depth--- .____._.._._____- _Ca acit <br /> is <br /> posal Fi Distance -from nearest well-�— Distance from foundation----�,Z__.-___.Distance to nearj�ra Flt,._l1�e-�_._... <br /> Number of lines_______ Length of each Ii Width of trench.__..�f_.__, -----._ � <br /> Type of filter material.__ __.�_._��_Depth of filter material____.145___...__.Total length-------- Q----- ---------_____.____-_ <br /> Seepage P Distance to nearest well —._ ----Distance from f undation__ C.�r___�.D1istance to nearest lot linee4_ --- <br /> 01-11 Number of pits---.--I------------ g �`�---Size: Diameter---T{--e....___Depth_ _. -o�----------- <br /> _Linin material________________ ,�. ___.____ <br /> Cesspool: Distance from nearest well________________Distance from foundation____- ------ Lining materiaL___.__.__ -----------------.--__-___ <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------- --- -------gals. <br /> Privy: Distance from nearest well __________________________----------------------Distance from nearest building--------------i----------------__-____--. <br /> ❑ Distance to nearest lot line-------------------------- -- ------ --------- --------------.......---- -------------------------•------------ .... 1 <br /> Remodeling and/or repairing (describe)--------- ----------- -----•-------- ------------------------------------•------- -------------------------------••------ ----- <br /> ' <br /> --....----•-•-•-----•-----------------•------------------------------------------------------------------------------------------------------------------•---- --------------------------------•-- <br /> - -------- - <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------••----•-----•------ -•------------------------------•----- i' <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,JSla , and les an regulation of +he San Joaqu' Local Health District.(Signed)----- --- -------------------- ---------------------- ------------- - G. ------------ -- � d7br Contractor) <br /> r <br /> $Y� �/�l- -- --------------------------------------------------------------------------- {Ti+le) '---- ----------------------- <br /> (Piot 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-- a------------------------------------------------- ---------------------------------------- DATE_------'--------------------------- <br /> REVIEWEDBY---------------------------- - .-------------------- ------------- ----------- --------------------------------- DATE-- <br /> BUILDING PERMIT ISSUED---------------------------------------- <br /> --------------------------------------------------- ----- DATE--------V`----------- <br /> Alterations and/or recommendations--------------- ---------------------------------------------------------------------------------------------------------------------•-------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------•--------------------------------------- <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 145445 4Twogo 1Z-S4 <br /> Y <br />