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,-� APPLICATION FOR SANITATION PERMIT Permit No. ________________________ <br /> Duplicate) <br /> (Complete in Du li , <br /> { P p• I Date Issued .14+1-1.�:s <br /> Applicaa-ion is hereby made to the San Joaquin Local Health District.f-or a permit to construct and install the work herein described. <br /> This application is made in compliance with CounK�A777:1,4,inance No:'549.JOB ADDRESS N .-D LO AT N ) j `''------------------------------------------------------------------------- <br /> Owner's Name t �--L------- ----- -------- - - <br /> --- <br /> -------------------------------------------------------------- Phone------------------------------------ <br /> Address__....-1--__T__-� / =� -.,. ..... <br /> Contractor's Name- - ---- -- --------- -------- -------- �'r �t��Sh--B -'--------------------------•----------------------- Phone----------------------------------- <br /> Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ <br /> Number of living units: -ZINNumber _�of bedrooms _ _._ Number of baths _1_____ Lot size .4��_--XJ9—Q_____________________________ <br /> Water Supply: Public systemCommunify system ❑ Private ❑ Depth to Water Table _---_.-. ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam E] Clay F] Adobe[j3/Hardpan <br /> Previous Application Made: Yes 0 No 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 /> Septic ank: Distance from nearest well-----------------Distance from foundation___________________.Material________________________.._____-_-____-_______- <br /> No. of compartments-------- -- -----,---.----,----/--JJ Size__..---------------------------Liquid depth---- ---------------------Capacity------------�--tt� <br /> Dispos Fie d- Distance from nearest w II--. -' CXA�stance from foundation__I_Q�istance to nearest lot lin�_NCM <br /> Number of lines__________ ____ Length of each line------- �l_.Width of trench_.____._ �--'' <br /> Type of filter maters - -- p g <br /> ' Se th of filter mater ial____.___._1�_____Total length <br /> __..-___.__-. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-.__.---____----_ <br /> ❑ Number of pits----------------------Lining material--------•---- ------ Size: Diameter--------------.--------Depth---------.----------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------.------------.Lining material-_.--.._..____._____________________- <br /> Size: Diameter____.--_________------- -----------De th__ — --------------------:-,-.Liquid_Ca au ------------------ .-_-_---gals. <br /> Privy: Distance from nearest well__._______.___________________________________Distance from nearest building________ ______________�___._.____._. \ <br /> [] Distance to nearest lot line--------- --------------------------------------•-------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe);-------------------------------------- ------- ----------------------•-•------------------------------------------------------------------------------ <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 /> (Signed) rte!- .^.._�--r _______Owner and/or Contractor <br /> By: � �. .r [rile) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE <br /> --- <br /> REVIEWED BY-------------------------- ---- - - DATE--- ----- <br /> BUILDING PERMIT ISSUED-------- ---------•-•-----•------------- -----------------<---------- ------------ DATE.---- t <br /> Alterations and/or recommendations:---------— 21..----- 57y----------------- = ------ .T„U---------•. -.. <br /> --------------------------------------------------------- a. - ---------------•-- <br /> // yy�J� �l <br /> --------------------- <br /> -------------- 4 1- .Y-----------------4 � -- <br /> ------------------------------ ------------------ ------- --------------- ------ - -----------------------------------------------------------------------------------------------------------------------------------•------- <br /> FINAL INSPECTION BY---------- ----------------------------------------­---------- Date-------------------- --- ------ --------��-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Stree} 132 Sycamore Street 814 North "C” Street <br /> Stockton, California Lodi, California Manteca,.California Tracy, California <br /> ES-9-2M ; Revised W-2100 <br />