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Permit N <br /> 'ON PERMIT o��-------------- , <br /> APP <br /> S- LICATION FOR SANITATION f tS^ <br /> ,I <br /> Y .. {Complete in Duplicate] Date Issued -„- <br /> ��N d <br /> uin Local <br /> Health District for a permit to construct and install the work here <br /> # described <br /> Application is hereby made to the Sae Joaq <br /> t-h h aur- <br /> -46 <br /> This application is made in compliance�,with�County Ordinance No. 549• <br /> F / a <br /> JOB ADDRESS AND LOCATION:------ - Phone------------ --- -- ---..,t-------- <br /> = ------- ----- <br /> ----------- -------------- <br /> Owner's Name -------- ------------------------------- <br /> ' ��� z �, - <br /> --- --- <br /> Address----------------------------------------- <br /> -----------•---------------•--=-------°- -- ---•--- one---- ------- -----------{ <br /> _ Ph <br /> `° - <br /> ' � � ----- �-�-l-----=----- -- ----- - Other <br /> Contractor's Name_ '-------•= Trailer Court ❑ Motel ❑ ❑ <br /> : . <br /> "Installation will serve Refdence A Apartmen#House ❑ Commercial ❑ <br /> "Je Number of baths -1----- Lot size -------------- <br /> r JA' ber lof living'`nits;.'- ----- Number of bedrooms _ (�Cp ft- <br /> I <br /> �;r <br /> Water Supply: Public system ❑ Community system ❑ Private g Depth to Water Table -Cla Adobe. Hardpan ❑ <br /> l� <br /> Character ofAsoil.to a deptEi of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Y ❑ <br /> .�-, New Construction: Yes No ❑ <br /> Previous A,p�plication-Made: Yes ❑ No <br /> TYPE OOAi TALLATION AND SPECIFICATIONS: <br /> ”" ( o septic tank or cesspool permitted if:public sewer is available`within 200 feet.] <br /> s' // �Aafieriall_C. �_------- <br /> Dimes#ark ��rom fAun t( - --- --- -- ,,I <br /> ll Liquid dep�h ----------------CaPaaty [ --------- <br /> I <br /> �--- m <br /> p "Tank: Distance from nearest wel4- --- / i <br /> Se t � No. of compartments--�------ Size._-- ----- ! <br /> 1� --r <br /> If <br /> n th of each line---- - - --- ----.Width of trench-.- <br /> *t3„posal Field: Distance from nearest wel4__-- Q----.-.Distance from toundation_.-'7 -----Distance to nearest <br /> o#;ne----------------- <br /> r - Leg <br /> Number of lines.---.--/-------- * �; Total len th Q <br /> Type of flier material__-: - ---------L-Depth of filter material----_-__-� �___-- g <br /> F z /r ° ` ___.-_.Distance�to nearest lot line_-- -•---- , <br /> __ Size: Diameter----- ---=------------ <br /> Seepage.Pit: Distance to`nearest well-_- 1 -------Distan frf�n a n-_- <br /> Unin materia ------ - <br /> Number of pits__-------�--- - --- g <br /> Distance from nearest well---------------`-Det{hce from foundation----------------- <br /> Distance <br /> --.-------_____Liquid Capacity matl----------------------------------- <br /> - --- ---.9a1� <br /> ,.Cesspool: ------------------ -----•-- <br /> . ❑ Size: Diameter------------------- ------- p <br /> Distance from nearest well----------------------------------------------- <br /> ------------------------ ----- ------------Distance from nearest building------.----------------------------------- <br /> Privy: <br /> --:---------•-------------'------ <br /> Privy: --------------------------------------------------- <br /> Distance <br /> ------------•---- <br /> ❑. Distance to nearest lot ine------------------------- <br /> ------------------- <br /> -------------------- <br /> -----------••------------••-- —------------- <br /> Remodeling and/or repairing (describe):------------------------ ------------------------------------------------ <br /> ...........­--------------------------------------------I.,---­------------------------------I-------------------- -------------------------- --------------------------------I----------------------------- <br /> I ­--------------------------------------------...... ------- <br /> ---------------•--- <br /> ----------------------------------- <br /> ty <br /> ------•--------------------------------------------------------------------------------------------------- <br /> 1 hereb certify that I have prepared this applicat'�eo a JoaquinhLocalk sell heDi frictclone � accordance with San Joaquin Coun <br /> ordinances, State law and rules'and•regula}ions of h Contractor] <br /> -c_�.�" <br /> ----------- <br /> --------------------- <br /> Sined - ---------------- <br /> 9 l {Ti#le] ds <br /> ------------------- <br /> -- ---- --- -------- <br /> B :------ <br /> - --- -------- <br /> -- , <br /> (plot plan, showi4g size of lot, location of sys em in relation to wells, buildings, a}c., can be p1 ced on reverse side) <br /> FOR DEPARTMENT USE ONLY <br /> DATE- / ----------------------------------- <br /> APPLICATION ACCEPTED BY-Q ----------------------- --------- - DATE----tai— ----------------------------------- <br /> ------------------------------------------- <br /> ------------------------------------------------------- <br /> REVIEWEDBY--------------------- ------- -- -------------------- DATE------- <br /> - - --------------------- <br /> ---- <br /> 5--------- ----------- <br /> FERMIS155UEQ-------------------- - -------------- --------------- ------------------------------------ - <br /> ----------------------------------------------------- <br /> Alterations and/or recommendations--------------------- - __----_____.--_______-----_.- <br /> ------•-------------•------------------- <br /> ------------ ----------- <br /> ----- <br /> FINAL INSPECTION BY:--------------- -- <br /> -------------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C' Street <br /> 300 West Oak Street Tracy, California <br /> 130 South American Street Lodi, California Manteca, California <br /> Stockton, California <br /> ES-4-2M s-51 Revised W-2100 <br />