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4 APPLICATION f09- SANITATION PERMIT Permit No. ._ `:_ _ _a__ <br /> (Complete in Duplicaite) S ,� <br /> Date Issued --- _.--- - _- <br /> r . <br /> A Application 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 Ordin ce No. S49. <br /> JOB ADDRESS ANDLOCATION.- - ------- -- -`----�------------------ ---------------------------------------------------------------------------- <br /> Owner's Name Z-2; ---� `-- ---- a = ----------!---------------------------------------------- Phone-_ " --------- <br /> __ <br /> Address--- � -------------- � - ----- --- -- -,.� � --- ------------------------------------------- - <br /> Contractor's Name 1--- -------------------------------------------------------------------------------------------- ---- Phone_, <br /> Installation will setve: Ress ence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __�___ Number of bedrooms : __ Number of baths __ __ Lot size ___ X �_________________________ <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 ❑ f <br /> Previous Application Made: Yes ❑ No"R/ New Construction: Yes No F1 <br /> TYPE OF INSTALLATION <br /> No septic tan 'or cesspool ermi# <br /> AND SPECIFICATIONS: \\ <br /> ( p p p ted if public sewer is available within 200 feet.) F <br /> Septic Tank. Distance from nearest well. 24r _Distance from foundation--- ----- ------Materiai1-> -z_?_______________________ s�1; <br /> No. of compartments!__�______________Size_l_-�11�`�?Liquid <br /> !/ <br /> Disposal Field: Distance from nearest well Distance from foundation-------------------Distance to nearest lot line---__----.-_____. <br /> ❑ Number of lines--------------------------- <br /> Type of filter mate --------Length of each line------------------------------Width of french----------------------------------- <br /> rsal-------------------------Depth of filter material-----------------------Total . length----------------------- ------------.----- <br /> Seepage Pit: Distance to nearest well 7-_._-z -_-L-_k__Disfance from foundation___f ../__Distance to nearest lot <br /> Number of pits____/_ r______Lining materialU , -t✓ -Size: Diameter____1 ��_��__ Depth---- -------------- <br /> -� <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_____________________________,_________- <br /> ❑ Distance to nearest lot line--------- ------------------------------- ------------------------------------------------------------------ <br /> -- ------------------------------- <br /> Remodeling and/or repairing (describXline <br /> , L f-----------------------------------------------------------------------•----------------------•-•----•---- <br /> ------------------------ <br /> ------------------------ --- -- - - <br /> - ---------------------------------------a- --------------- -------------------------------------------------------------------------------------------------------------------------------- ---- <br /> I hereby certifyprepared <br /> that I have re ared this application and that theework will be done in accordance with San Joaquin County <br /> ordinances, Sfate l s, and rules nd.,iftgulations of the San Joaquin Local,Health District. <br /> (Signed)---- --------- -- � ------ % /no-f <br /> il --------------- �"- --------- ------------------------------- -----(Owner and/or Contractor] <br /> s r. <br /> By--------------------------------------------- 3 ' � f'� = ,----------------------{Ti+Ie� ---------------------------------------- <br /> (Plot <br /> _-�.- --"--- <br /> (Plot plan, showing size of lot, locatiystem in r aVon fo ells, buildings, etc., can be placed on reverse side). <br /> r <br /> FOR DEPARTMENT USE ONLY <br /> 2. <br /> APPLICATION ACCEPTED BY�------- ----- -------- --------------------------------------------------------------- DATE__' -----------•----------------------------------------- <br /> REVII WED BY - DATE �""'- <br /> r ------:. - ---.-- ---------------------------- <br /> BUILDING PERMIT ISSUED--------------- ------'------------------------------------------------------------------------------ DATE----- - ------------------ --------------- <br /> Afferati- ---n In <br /> -------------- d/or recommen hio s:__ _'; __ <br /> , <br /> ---- '----- -------- ---------------------------------------------------- ---------------------------------------------------------------------- <br /> ------------------------------- ---- --------------------------------------------------------------- ------ ------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:"-W,4---------------------------------- __x Date--------- -- -- '�-��s--------------------- <br /> 5' SAN JOAQUfN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California 'i Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-S1 Revised W-2100 <br />