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APPLICATION FOR SANITATION PERMIT Permit No.S_ _�___ <br /> �. (Complete in Duplicate) ,{ v <br /> Date Issued <br /> Applica-lion is hereby made to the San Joaquin Local Health District for a permit to construct and 'nstall fihe heed <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__ - <br /> -- -- <br /> Owner's Name ' -- •----• -------- <br /> Owner's <br /> -- -----�3�w <br /> ----------------------- -- <br /> - ------------------------ <br /> Address------ - ---�---��--------=��--�/'--==� -[,Z,+--Y-�..----�f�-� _ <br /> = - <br /> Contractor's Name.-. 2 -. •---- /-.. f <br /> ------------- <br /> Phoned�j__G_r• =,� .__�4_' <br /> Installation will serve: Residence Pq—Apartmenf.House ❑ Commercial>[] Trailer Court ' <br /> ❑ Motel ❑ Other ❑ <br /> Number of living units: __j_._ Number of bedrooms ._ _ Number of baths __�-__ Lot size ---/--- ; - ______ __ <br /> Water Supply: Publics stem _ommunit system-0, <br /> _#, pP Y� Y � Y Private F-1 to Water Table -------- ft:r <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay dobe 8-•Hardpan ❑ <br /> Previous Application Made: Yes ❑ No A---New Construction: Yes ❑D <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �~ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> t ` <br /> Septic Tank: Distance from nearest well_ z�-4___Distance from foundation__- __---__._- Material---C /i.Z <br /> -- -------- <br /> No. of compartments---------Z-------------Size__ -- (-L/-�,----------Liquid depth----� --1-- <br /> ----------Capacit -----e�--0--�------ <br /> Disposal Field: Distance from no weil_ Lcx -,_Distance from foundation----- .f � <br /> 14— _Distance to nearest lot Z1------- <br /> ­ <br /> of lines---------- ------- Length of each line-------- ------.Width of trench---2_Sf--------------- <br /> Type of filter material-,/_ �1 -/�----.Depth of filter material-----I-cQ--__`�___--_Total length-------f-L-J_:'_____________ <br /> Seepage Pit: Distance to nearest well------------- from foundation--------------------Distance to nearest lot line----- <br /> 1-1 Number of pits--------- <br /> --------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------___ ___ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-_------_-_ <br /> ❑ Size: Diameter------------------------- ---- <br /> Depth -------- -- - -------- ---------Liquid Ca•pacify------------ ---------- ---gals. <br /> Privy: Distance from nearest well--------__--------------------- <br /> -----------------Distance from nearest building------ <br /> Disfiance'to nearest lot line _ -------- ----- <br /> ------------- = --•-- s <br /> -------------------- <br /> Remodeling and/or repairingdescribe):---_-----____-------------- <br /> ------------------ <br /> ------------------------------ <br /> ---------------------------------------------------------•------------ <br /> ------------------------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> r , / <br /> (Signed 1 � � <br /> ---------------------------- <br /> -- Title_- ` �. "�Contractor) <br /> (Plot plan, showing size of lot, location`of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> ( J --- <br /> J - � <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----_.-____ <br /> DATE . <br /> REVIEWED BY------------------------- ----- _ <br /> ------ ------ ---- ----------- 1' <br /> ------ -------------------- - <br /> ------- ---------- - DATE---•--------•-----••---•- - - <br /> BUILDING PERMIT ISSUED------------ •--- ----- <br /> - --------- --------------------------------- ---------------- DATE---------------------•---------- ------- -------•---------- <br /> � t rations d/or rgcommendations:i--------------�--__,-_ <br /> AI ------ ---- <br /> . - r _ ---------- -i--• <br /> ... <br /> �.� .� - -- <br /> f �l <br /> ------------------------- <br /> �-------1 _ _-; - r?------- - ---� :_` - -------------------- <br /> FINAL <br /> ) <br /> INSPECTION BY:------- ,� <br /> T _• Date.... � s -- °----- -.- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT _ <br /> � 130 South American Street <br /> 300 West Oak Street 132 Sycamore Street 814 Norah "C" Street _ <br /> Stockton, California <br /> . v Lodi, California Manteca, California Tracy, California <br /> 9-2M Revised W-2)00 <br /> jr <br />