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APPLICATION FOR SANITATION PERMIT Permit No. ...�I _.. <br /> 1 /� <br /> (Complete in Duplicate) >AAX <br /> Date issued ----__ ____ __ <br /> 57 <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 LOC;TION-------- ----- --'---`------------------ --P✓-- -- ------------------------------------------------- <br /> Owner's Name _ r <br /> Phone. _.------- --------------• -•---- --------------------------- -- -----' <br /> ------------ `S2,Address <br /> `-- (-- q.__--- <br /> Contractor's Name--- ` .. C' l/L- -- --------- `j -4:4S-----'------------------------------------------------- <br /> Installation will serve: Residence ®. Apartment House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:--- ____. Number of bedrooms _��—. Number of baths -1----- Lot size ---- _ .- c ----------------------___ <br /> Water' Supply: Public system ]--Community system ❑ Private ❑ Depth•to Water Table -fes <br /> Character of soil to a depth of-3 feet: Sand.❑ Gravel ❑ ,.Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I}J=lardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction:Yes❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: { ` <br /> (No septic tank Ior cess}sool permitted if public sewer is available within 200 feet.) <br /> 1.Septic Tank: Distance from nearest well_____ _________Distance from foundation_---_--_-_-----_-.-.Material--------'--------_-._-_-_--_. -_--.-_-_--..... <br /> N of compartments--------------------- ----Size-------•-----------------------Liquid dep#h-----=----- ------------Capacity- ------ <br /> Disposal Field: Distance from nearest well...l - �'-0istance from foundation __.__Distance to nearest lot line <br /> 17 <br /> lines__-___;-__ /� ,LDength of each line--_�d ------------ <br /> t.-.Width of trench......-�_4C:___________________ <br /> Type or filter mateIf <br /> ria - - _ epth of filter material----_- _- f_-----Total length--_--�L�-----------------------•-- <br /> ' -__--_Distance from foundat.ion---_-__.--�-__.Distance to nearest lot line---------------_ 9 <br /> Seepage Pit: - Distance to nearest well-__________.�. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diametei•-------------------------Depth--------------------------------- W <br /> Cesspool: Distance from nearest-well----------------Distance from foundation----------------_--.Lining material-------..__--_-._---.----- _--- <br /> 'Si 'Diari�eter= - <br /> ---------- Dep#ham =_,::_------------------- <br /> L <br /> _---=-_-=_- q p Y --------- <br /> _e. ;9a� ' <br /> s' � a <br /> Privy: Distance from nearest well----------------�..___.________--.-------- Distance from nearest building.--...------------------------------------ <br /> - <br /> -----------_-__---_--_-----_----. <br /> ❑ _ . ,� ..,, . Distar'ce•to-nearest,lot'line-----=`---------=--=- - "- -------------- -----------------=-------------=-------------------- Q✓ <br /> . <br /> . r <br /> Remodeling and/or repairing (descre�---------------------- � �Lr~�cr�%�sh_ ----------------- --------•-•----------------•---------------------------- <br /> 1 <br /> -------- -------------------- <br /> K .. r t# <br /> -----------•---------------------•--.----------- <br /> 1.:. . . ------------------- --- ---•-------------------------------•--- <br /> ------------------•-------- -------------------------------• - <br /> 1-hereby certify +hat'1 haveprepared this application and that the work will-be done in accordance with San Joaquin County <br /> ordinances, State lawst-and rules and regulations of'the San Joaquin Local Health District. <br /> -- - ----------.-----------(Owner and/or Contractor) <br /> By:.--,Z,.- a_?. -- --- ---------------------------------------(Title)----- ------------------------------------------- <br /> (Plot plan", showing size of lot, Iota+ion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED. BY = DATEf �-Jy�------ <br /> 'REVIEWED BY------------1•---------------------=-------'-------------------=--------=------------------------------------------------ DATE-----------------:----------------------------------------- <br /> BUILDING PERMIT ISSUED---------_---I----------- ----- DATE:--------------------------------------•--------`-------- <br /> Alterationsand/or.recommendations-------------•-------------------- ------- -------------------_............------------------------•................. --------•------ ----------- <br /> --------------------------------- <br /> t } <br /> 1 ' <br /> ------------------ ------------­- ----------------------------------•----------------------------- --------------------------------------- <br /> •----•---------------•--------------•---------•------..---------------=•---------------•------------------------------------------------------••--------- <br /> F - � <br /> ---'------'------------'-'------------;---'--. ----------------------'-'---•'-'- --•-----'--------------- ---------'�----F'-'----Date.-----._. _...--------'------'-----..------------------------------------- <br /> SAN <br /> --------- •--•-----•#•-----'-- <br /> FINAL INSPECTION BY---------------- -------:-----._. f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> �`. ES-9---2'M ; Revised W2100 - <br />