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eft <br /> L�� I^ tQ l y✓'� APPLICATION FOR SANITATION PERMIT Permit o%2a... <br /> U /,f✓�� (Complete in Duplicate) <br /> �W Date Issued <br /> ©s- p-02,D^0 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the <br /> work her "n des d. <br /> This application is made in compliance with County Ordinal e o. 549. <br /> TD`RE �• QrCa4S1C Jl ye�� <br /> JOB ADDRESS AND-tOCATION . .., ...._ _.. `��7 _- _ ----- - --. -.. <br /> f/ - <br /> Owner's Nama- - ---------------------------- Phon �� <br /> --. <br /> Address- - - 9�------------------.....---------...... .............................._...._ <br /> - - <br /> Contractor's Name.............----- --- - Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ qMotel ❑ Other ❑ 1 <br /> Number of living units: ..... Number of bedroomswet, Number of baths _/_ Lot size Fn ............. <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ AdobjotP( Hardpan ❑§ <br /> Previous Application Made: Yes ❑ N,X New Construction: Ne No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public pwer is available within 200 feet. <br /> Septic Tank: Distance from nearest well ...... ---.. istance from <br /> .p. .. froun..dation__ ___.. .. . � - �- <br /> r <br /> -- --- aera...._ <br /> No, of compartments.... ___ ------ _ ( Liquid depth... � - P.a acitY-_.. .. .. -- <br /> i <br /> I <br /> Disposal Field: Distance from nearest well __.. istance from foundation_ Distance to nearest lot line..�s+..1 11 <br /> Number of lines------._............ . .....Length of each line.... _._ __.... <br /> of trench... 2� . <br /> Type of filter material . ......... .....De Depth of filter material___. -_ r...... .................................r. ....... '-- <br /> YP p ..To+el length.. ` <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.....................................Depth.-----------..................-......---- -----Liquid Capacity---_---•----------......gals. � <br /> Privy- Distance from nearest well--...............................................Distance from nearest buildingI <br /> ❑y .......................................-------........ ........------ -•----........ <br /> Distance to nearest lot line.................... <br /> Remodeling and/or repairing (describe):.......... <br /> '017 <br /> describe):.......... .. ... ........ ........ <br /> ----.............•-...... ---....................----­---------------- --- ...........- ........................................................-................................. ....................... <br /> -•........--................•......,------...........•----------•--------------------............-............................ ..........................................---------............................ <br /> ---------------------------------------------------------------------------•---.......------------------------------------------._...--------------................................-------------------_-- -------- <br /> hereby certify That I have epar this application and that the work will be done in accordance with San Joaquin Counfy <br /> ordinances, State and rul nd egulations of the San Joaquin Local Health District. <br /> (Signed) (Owner and/or Contractor) <br /> By:........ .... -a..... . .... -•----.............--•-------------..................---------. - -(Title). 09•-- .4,r,n ! , <br /> (Plot plan, showing size of to{, location of system in relefion to wells, buildings, arc., can be p aced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. .................... DATE.- ' -- - <br /> REVIEWED BY------------------ ------- ---- -- - - DATE--- ----------------- <br /> --------- �----� ---- • -------- ------------------------------------------'-------- -------------------- <br /> BUILDING PERMIT ISSUED ......................---................................-......................... DATE-------- <br /> Z' - <br /> Alterations and/or recommendations:...._..---------------...........--_............................................................................................----------------------- <br /> ------------------------...--------------------------__.........-•---------..................................­­....................................... ......... - - ---•--------------------------- <br /> --•..................................-----........................ .....................................................................----............................................................. <br /> ---....... .......-..........-..........................I——............................--......---- ................-........................_-............... ' ---......................................... <br /> FINAL INSPECTION BY:----tt ':.J� tlt.:h9 tY..------- Date.. .....� '--a�--`' - .. .. - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West CA Sfreet 132 Sycamore Street 014 North "C" Sorest <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 0-51 Revised W-2100 <br />