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�q , <br /> th k \ APPLICATION FOR SANITATION PERMIT Permit NQ,: '_ ._..-K.-.... <br /> Duplicate)V in Du <br /> (Complete P I Date Issued <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to cons uct and install the work hereinscri <br /> This application is made in compliant ith County Ordinance No. 549 ,.,,, <br /> JOB ADDRESS A L CATION. ------- <br /> ------------------------------------------------ <br /> --- •.........- -......,------ <br /> Owner's Name------ <br /> - .- --- <br /> Address _ f -- -------- <br /> -7 <br /> Contractor's Name---------------------- --------- ------- ---------------------------------------------------- Phone <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑AMotel ❑ Otherv__ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -_______________________ <br /> Water Supply: Public system [A ' ommunity 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 rc pan ❑ <br /> Previous Application Made: Yes ❑ NZ4 -.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 jell_ __Dista�n/ce�fro oun tion lJ Ma ger ial ___ _--. <br /> No. of compartments_.!_._.. ._._____.__Size!YYr� _ <br /> - ---- --�tiquod depth- -------- ----Capacity .-jam <br /> Disposal Field: Distance from nearest wellY1 _Distance from foundation__/_jO--_-----.Distance to nearest lot line..,t�0..,;... <br /> Number of lines.__ -------- --__ Length of each line..../,57'_"'"_---___..Width of tre _7_�--___- �- -�.. <br /> Type of filter mate rial__Ak1_____ --Depth of filter material------/g- -----Total length/ _--_j6................ <br /> Seepage Pit: Distance to nearest well----------------------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 well -..---------------.-----------------------------Distance from nearest building----------------------------------------- t <br /> ❑ Distance to nearest lot line-------------------------------------------------------------------------------- ------------=---------•--------------•--------------------- .,1•' <br /> Remodeling and/or repairing (describe)"--- ------ -----_11.,._t----_411 <br /> ----- --------------------------•-------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------•--------------------------------------- <br /> 1 hereby er that I have pr ared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, late I ws, and r les a regulations of the San Joaquin Local Health District. <br /> (Signed)------ ........... .... --- ----------- ---- --- ----------------. ------------------rced <br /> ------ <br /> By: <br /> - ntractor) <br /> B --------------•---------------•--•-•-••----------------------------------- L ��21 <br /> Y - - --- -------- ------------------(Title)-(Plot plan, showing size of lot, location of system in re t on to wells, build' gs, etc., can be pn reverse side). <br /> FOR UEPARTMENT US ONLY <br /> APPLICATION ACCEPTED BY ,, - ------------------------------------------------------------------------------------ DATE '---------------------------------------------- <br /> REVIEW <br /> .- <br /> REVIEWED BY-------------------------------` 3- --. DATE----:9^-••---...------------------------•----•------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE...........*".......................................... <br /> Alterations and/or recommendations:--------- --------------------------------------.............-••------•---•--•----------------------------------•---------------------------------------- <br /> -------------J.'. <br /> Af ----------­----- ---------- . . ............ <br /> r -- <br /> i t....:i_..�„}.sc-u-ct�.v�" -ry,c.trf$-''4 -"•m'r.__�W""_.��»..�:� ,."�.»t.,.--�L-_.._�_.__r.�a?_...���y�- --iv°'�---.,t��.a»4L.- '_t "_`rplw�-_�_Z 1�--•`_'.i+��,; -* --* <br /> FINAL INSPECTION BY:..------- t---� L--//16--------------- Date---- r-----.- _`' ' <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 />