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APPLICATION FOR SANITATION PERMIT Permit Na.. _ _ _0--- <br /> (Complete in Duplicate) 1- <br /> el� Date Issued)®_,,?9 -- <br /> Applica+ion is hereby made to the San Joaquin Local Health District r a permit to construct and install the work herein described. <br /> This application is made in compliance wit County Ordinance No. p2p, <br /> JOB ADDRESS AND LOCATION vA <br /> ----- -- - ----•- -' -• • <br /> �-� <br /> - - -- - ----------- -- --- <br /> Owner's Name /�� ----------a5 -e- -------------------------------------- Phone- _�_ - <br /> --- <br /> Address------------------- f f <br /> Contractor's Name--•------------------------------ -----1 --_-. - + ----�---------------------------------------- Phone---�.��._-�.-�...'/ . <br /> Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I____ Number of bedrooms J__ Number of baths ---t. Lot size ____________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablet.. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam [:] Clay E] Adobe�ardpan El <br /> Previous Application Made: Yes E] No New Construction: Yes, Flo ❑ `\ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest we ��t✓_Distance from foundation__�d_ ------Materia)------- :-------- <br /> - <br /> No. of compartments_______ _ ______________Size__ �s�' � Liquid depth----�, - ---------Capacity_-9-19Jg0_ O, <br /> p <br /> Disposal Field: Distance from nearest welf._ _Dx+"_/.._Distarice from foundation---z- .........Distance to nearest lot line___7-_�� <br /> [ � Number of lines---.----I----- --------i----------Length of each line----------41570-- --_----Width of trench- -- -Q-"--------------- <br /> Type of filter mate ria l_____..__2___ k---Depth of filter material---------/.g"____Total length______ _°_' <br /> Seepage Pit: Distance to nearest _------Distance om ,dation__..�Q.`.__..Distance to nearest lot line....s�__�____ <br /> ❑� Number of pits Lining materi I_ �Size: Diameter 3 Depth !<�r �- <br /> --- ------------ <br /> Cesspool: Distance #rom nearest well---------------- rdrth fo�dation__________________Lining material--------------- ___________________ <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------•----- -- ----------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well _________________________________.________--_--Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line " _ ---y--- ------------------------------------------------------------------------------------------------------•----------------- <br /> Remodeling and/or repairing (describe)------------------------------------------------------------------------------•-------------------------------------------------------------------------- <br /> ­-----------------------------------:-----------­----------------:------*----------------------------------------------------------- --------------- <br /> -----------------------•---------•----------------------------------•----------••-----------•----------••---------------------------------------------------------------------------•----------------------------•- ------------------------------=------ <br /> u <br /> --------------------------------------------------------------------------------------------•-----.._... ----------------------------------------------------------------------------------.-------------------------------- <br /> ---. .. ---- - ----- --------•------------------•--•--•---------------------------------------•--•-•-------------- -----------------------------•--------------•----------------•---------------- <br /> I hereby gertify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St to aws, an rules and regulations of the San Joaquin Local Health District. <br /> (Signed).......... -1 f���1}S �----- In--�2=---------------- - --- -------------------------------------------------(Q�. -Contractor] <br /> By: ------------------------------------------------------ ---- `�".--- --.- ------- (Title__. -- <br /> - - a-+rte- -�--a.�'. <br /> (Plot plan, showing size of lot, location of system in re tion to wells, buildin , etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- ---------------------------------------------------------------------------- ------------- DATE 533 <br /> REVIEWEDBY.----------------------- - - - --------------------- ---------------•- ------------------------------------- DATE- <br /> BUILDING PERMIT ISSUED._.. DATE _t------------------------------------------------ <br /> Alterations and/or recommendations:-•-------------- ----- -----------------------------------•------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------- ------------ ----------------------------------------------------------------------------------------------•---------------------------------------------- <br /> ---------- <br /> --------------------------------------•-----. <br /> --------------------------------------------------------------------------------------------------------------- --------._..------------------------------------------------------------------------------------------------ <br /> --------------------------------------------- ------- ---- - --- --------------------- <br /> Date <br /> ��y <br /> j <br /> FINAL INSPECTION BY:-�----- - -'------------------------ ....................... ---•- -. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised W-2100 <br />