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Ix 4 <br /> APPLICATION FOR SANITATION PERMIT Permit No. . --- _ <br /> (Complete in Duplicate) <br /> � bate Issued <br /> Applicafion 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 LOCATION::_____2216____TE10 bl ad ale------------------- <br /> --------- ---------------------------------------•---------------------- <br /> Owner's Name---------------11'_ E _-If,_QQT;1,g_iOC <br /> s- ---••---------- ---------------- ----------------- ------------ Phone--5->67G�---------------- <br /> Address--------- __� _ <br /> ------------------------------------------------------------------------------ ----------------------------•---------------- <br /> Contractor's Name----------- - <br /> ---------------------- ------------------ -------------------------------------------- --------- Phone------j--"�9.�_5------------ <br /> Installation will serve: Residence [3. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1---- Number of bedrooms 1_--- Number of bathsl------ Lot size .._-----100X44------------- <br /> Water Supply: Public system E Community system ❑ Private [❑ Depth to Water Table P-O-- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe IN Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Ell: 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 /> i <br /> Septic Tank: Distance from nearest welliaone------Distance from foundation------g, <br /> --------- Material----Oem2r?t--sa?''_1ak---------- <br /> No. of compartments------2-----------------Size----- _1 f `-----Liquid depth--- ' 3-----------Capacity-----800--------_-� <br /> Disposal Field: Distance from nearest well-----------------Distance from"foundation___--_-----_-_--_-Distance to nearest lot line_---_-._----____. <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench <br /> Type of fuer material----------------------__Depth of filter material----------------------- length-------.----_-_-._-_------_-_ <br /> ------------- <br /> Seepage Pit: Distance to nearest well __none---____Distance from foundation------11Q!.......Distance to nearest lot line--------1��---.- <br /> 0 Number-of pits-------Z-------_---Lining material--__'QrJL_0,k-----Size: Diameter__42................Depth. <br /> --14R---------------------- <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 (describe)-------- RC1-------------------------- + <br /> 1 <br /> --------------••------------------------------------------- <br /> - -------------------------------------------------------------•----------•----------.---------------••----------•--------:----------:-------------------------- <br /> I hereby certify that I have prepared Aij application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulatr ns of the San Joaquin Local Health District. <br /> (Signed)------------------------------ <br /> L,3 1 -----------------------(Owner and/or Contractor) <br /> ----- --------------- -- <br /> By:--------------------------------------------Parr-Y- '�Tarthan.-- �i�S­6uildings, <br /> r ------------------- <br /> (Plo+ plan, showing size of lat, location of system in relation o wetc., can be.placed on reverse side). <br /> ? FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY1 _.------ ----------------------------------------------------------- DATE <br /> -- <br /> - - -- -------------- <br /> REVIEWED BY--------------------------------------------- ------ ----------------------------------------------------------------------- DATE <br /> ........... <br /> BUILDING PERMIT ISSUED-------------------------- ------------ -------------------- DATE------- <br /> Alterations and/or recommendations----------- --- - --------------------------------------------------------------------------------•-------•----= <br /> -------------------=-- <br /> --------------------•--- ---------.----------------•-------------------------------- _------ <br /> ------------=------------------------------------------•----------------------------- ----------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------•------- ------ <br /> ---------------------------------------- •------------- ------ -- <br /> --------------------------- <br /> FINAL INSPECTION <br /> BY:- -------------------- %-----------------------------�+ Date--- <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> b <br /> 130 South American Sfreef 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M B-51 Revised W-2100 <br />