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s <br /> APPLICATION FOR SANITATION PERMIT Permit __3._ . <br /> (Complete in Duplicate) �^ <br /> Date Issued /Q__s___,x____..� <br /> Applica+ion 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 Ord' ante No. 549. <br /> JOB ADDRESS A D L CATIOIl N,,---�------- - ----- ------------ ------ ------e--------- '------------------------------------•---•------------ <br /> Owner's Name------ - ---- -------------3 l_------ ------- ----------- --- ------ - - -4------ - ----- ------------------------------------ Phone------- -------------- <br /> Address-----•-•------------ ------------ - ---------- _ -> _-a.-------------------_- ----------••---------------------------------------------------------------.- ----------­-­­-------- <br /> Contractor's <br /> ------------•- -------- <br /> '; -------------------------------------------•--- Phone--;- <br /> Installation <br /> hone-- <br /> Contractor s Name--------------- ----��'.1---�- -- -------�- �-�-------- ------------- <br /> Installation will serve: Residence Apartment House [3„, Commercial E] Trailer Court ❑ Motel E] Other ❑ <br /> Number of living units: j---- Number of bedrooms ___Y Number of baths -,/____ Lot size __/_ _---,- _1_ --------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _Aloft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑- Clay ❑ Adobe En--'Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ jXP�r �..,.. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 ff// <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> tic Tank Distance from nearest well_________________Distance from-fou ndation______=____._..__-.Material____________.___----_____-___-----.----_____-___. <br /> No. of compartments-------------------------Size_..-....------------------------Liquid depth--------------------------Capacity----------------------- <br /> osal Distance from nearest well_________________Distance from foundation________._________.Distance to nearest lot line__-_____.____-___ <br /> Number of lines---------------------------- of each line-------_---------------____--.Width of trench.-----------------------------___-- <br /> Ypp material-----------------------Total length----------------------------------------- <br /> f / <br /> Seepage P' Distance f tloenear st//Iwlell 1@A£_______D Stan o f filter <br /> undation__�Q_ ....___.D'st nce to nearest lot line-__�_• --- <br /> Numberof pits-_ -1_--------------Lining material____ __ -A-__-Size: Diameter___��ff-----_Depth__.��o___-___________ <br /> Cesspool: Distance from nearest-well----------------- from foundation---------------------Lining material________________._____--_--_____.-_•_ <br /> ❑ Size: Diameter--------------------------------------Depth---:----------------------------- ------Liquid Capacity----------------------------gals. <br /> Privy:' Distance from nearest well-------------------------------_-----------------Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line-----------------------------`------------------•---------------------- ---------------------------- .------------.-------------------------- <br /> Remodeling and/or repairing (describe):________________________ - <br /> I <br /> --------------•------------------------•-•------------------------•--------------------------------------------------------------------•-----.........---------------------•----------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------” <br /> I herebyerfi that I have pApared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Slate�s,,an ules regulations oft San oaquin oca{ Health District. -- ------------ ---------------------------------------- t Contractor(Signed----------- ----- -------------------------------- I <br /> ------ t ) ---------------- <br /> (Plot plan, showing size of lot, location of system in r ion to wells, buildi gs, etc., can be placed on reverse side). <br /> FO EPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY -------------------- ----------------------------------------------------------------------- DATE�------....---------------------------------------- <br /> REVIEWED BY---------------------- ----- . ------ DATE._-.1._.. <br /> BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------------•-•-----•---- DATE----- -------------- ----------------------------- <br /> Alterationsand/or recommendations:---------------------------------------------------------------------------------------------------------------t ............. ----------------------- <br /> 1 <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------•---------------------------:------------------------------------------------------------------------------------------- ------------------------•------------------------------------------- <br /> ------------------------------ ----- -------------------------------------------•----------- ---------------------------------- ------------------------------------------------------- <br /> y <br /> FINAL INSPECTION BY:-------------------------------- -------- ----- Date-----------------j y <br /> Ic <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M ; ' Revised W-2100 <br />