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�,tjg,&TION FOR SANITATION PERMIT Permit No. <br /> k, (Complete in Duplicate) <br /> Date Issued <br /> eh, m e' <br /> A y P <br /> This <br /> is here ma to the San Joaquin Local Health District for a'perm;t to construct and install the work herein described. <br /> is application is made incompliance with County Or ante N�P..549. <br /> JOB ADDRESS AND L06ATION------ ------ ------------------------------------ -------------- <br /> Owner's Name-------- .. ------------------------------ ----------------------------------------- Phone /-T <br /> Address--------------------_-_--- ------- --------------------------------------------------------------------------------------------------------------------------11------------------------ <br /> Contrador's Name-------------- - - -- - ----------- --------------------------------------------------------------------------------­,­----- Phone------------------------------------ <br /> Installation will serve: Residence Apartment House E] Commercial 0 Trailer Court E] Motel 0 Other [I <br /> Number of living units: J----�Iumber of bedrooms Number of baths ---J_ Lot size ---- <br /> Number of <br /> Supply: Public system Community system 0 Private F-1 Depth to Water Table ------- ff. <br /> Character of soil to a depth of 3 fee+: Sand E] Gravel Ej Sandy Loam E] Clay Loam El Clay ❑ Adobe Hardpan E] <br /> Previous Application Made: Yes E:1 No x New Construction: Yes x No E] <br /> TYPE OF INSTALLATION I AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted ifpu .�I- sewer is available within 200 feet.) <br /> w- <br /> Septic Tank: Distance from nearest well- Distance from fou?nda on---/__0----------Mat ri --- ------ <br /> e ri <br /> 100i 0 <br /> oe------ <br /> Liquid depth------------ -------------Capacity <br /> No. of�compartmenfs-------A-------- <br /> Disposal Field: Distance from nearest well__"__.Disfance from foundation---- Distance to nearest lot lin <br /> , <br /> Number of lines-----------x <br /> _13aidfh of french- ,Q---- ---------------- <br /> - <br /> - <br /> Type of filter material------&_V_ ,�_ Qepfh Length of each line________of filter material-----1,8!--------Total ----------------- <br /> Seepage Pit: Distance to nearest well--------- ------------Distance from foundation--------------------Distance to nearest <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: Distanre from nearest well-----------------i--------------------------------Distance from nearest buildin❑ g------------------------------------------ <br /> t}isfance to nearest lot line---------------------------------- ----------------------------------------------------------------------- --------------------- <br /> Remodelingand/or repairing (describe):----------------------7----------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- -------------------­--------------------­­_­----------------------------------------------- -----------­------------------------------------------------------------------------- <br /> --------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared Ais application and that the work will be done in accordance with San Joaquin County <br /> ii ordinance State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ........ ----------------------------------(Owner and/or Contractor) <br /> {Signed)-----------111"- ------------------------------------------------------------------------------ <br /> By:------------------------------------------------------------------------------------------------------------------------------------ <br /> Title---------------------------------------------------------------- - <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 /> ---------------------- DATE_--------------------- 6------------------------ <br /> APPLICATION ACCEPTED BY---------- ...------•••------------ --- -------- --- ------------ _;_1-- <br /> REVIEWEDBY--------------------------------------------- -- - -- -- - - - --- --------------------------------------- DA ---------------------------------- <br /> BUILDING PERMIT ISSUE.D------------------------------- ­- - DATE-------------------------------- -------------------- <br /> TE----------�\_.�2--- - <br /> - - - ----------------------------------------------------- DATE-------------------------------- ---------------------------- <br /> Alterations and/or recommendations:------Z, ------------------------------- ------------------------------------------------------------------------------------------------------------ <br /> - \ I------------ <br /> - / '`s"------------------ -- ---- ---------------------- <br /> 7 r-ai'Y fit'- ----- <br /> -----------T--------------lix------ ---------------- ---------- -- ----------------- - ------------- --------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------- <br /> --------------------- .........:70-4 Lf-------- <br /> --------------------------------------------------------------------------------------------------------------- ---------------------------------------- -------------------------------------- ----------------------------- <br /> FINAL INSPECTION BY:-------- ------ ---------------- <br /> Date-------------------/-- --------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7 <br /> 130 South American Street 306 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />