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-7 <br /> APPLICATION FOR. SANITATION PERMIT Permit NojA.1_.2—. <br /> 0 (Complete in Duplicate) <br /> Date lssued,:5_ <br /> Application is hereby made"fo 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 Ordinance No. 549. <br /> yam' <br /> JOB AD SS AND LO A 10 .......... <br /> Own's ZA <br /> ......................... Phone............. <br /> Address.............. ... . ..... ......... ............... <br /> ............................................................................... <br /> Contractor's Name... ...........il 11........... ...............---------- ................. .••---•-•---.....----••----.................. Phone.................................. <br /> Installation will serve: Residence Apar enf House L]. Commercial [] Trailer Court E] Motel F] Other 0 <br /> Number of living units: <br /> ---- Number of bedrooms -Number of baths ... .._.Lot <br /> Wafer Supply: Public system E] Community system E] Private Depth to Water Table T_ .... ft. <br /> Character of soil to a depf hof 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam El Clay[I AdobeAq Hardpan E] <br /> , <br /> i: <br /> Previous Application Made:IlYes F No N Ye No 0 <br /> New Construction: s <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distancelfrom nearest well... O_Aistanq fro found n.... .._ ........Mate lai....... ----------- <br /> P,cify..p <br /> No. of compartments ._...___...Size_..._..-----------Size_. Liquid dep�h......... ..... <br /> .._.. ._k <br /> K ........Capacity---- -- --------- <br /> D;sposal Field: Distance from nearest W611----jseJ__.._Disfance from founclation...1.0.......Distance to nearest lot line ....... <br /> Number of lines...........I.....................Length of each line-...../.,'1.40�7.........Width of trench..2,4. <br /> Type of filter material...J_-r.� <br /> epfh of filftr material.-.-- ---9_'P.....Total length....... ................... <br /> Seepage Pit: Distance c; nearest well.......................Distance from foundation......___.......Distance to nearest lot line......_....__._-. <br /> F-1 Number of pits-------__-----_-Lining material----------------------Size. Diameter........................Depth....................... <br /> . <br /> Cesspool. Distance,from nearest well.................Distance from foundation._..._..............Lining material..-..-..-_-_-..__.................... <br /> S:ze:-.Diameter.--, -• .-._._...-.-...---_7,W.,*. -- - --------Depth....... Liquid. Cap it <br /> Privy: <br /> DiJance'':4rom nearest well....._ ....:.................................Distance from nearest building.................... ............... <br /> ❑ <br /> Distance.fo, nearest lot line........................... .... <br /> Remodeling and/or pairing (clescribe):__,....... ........ ......... <br /> r r <br /> I 1 44 .. ...... . <br /> .................................I.............. -------------- _-------_--------------------_-- ............... <br /> 7----------------------------------- <br /> ..............................................................................................................................................................­­................................-..._•--........ <br /> ---------------------------------- --­----- ---Ii.......................----------------------.............................................. <br /> ­---------------------------------------------------------------*---------- <br /> I hereby certify that I h4ve prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulation L f the San Joaquin Local Health District. <br /> (Signed... Ruv ..... .W.. ......... .I................ ............... .......------- <br /> -----------------------------......... ....(Owner and/or Contractor) <br /> BY:.......................................................... ......................... _...(Tiltlel <br /> (Plot plan, showing size of lot;location of system in relation to wells, buildings, etc., can be placed an reverse side). <br /> 1. FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... <br /> .................. DATE.......................... <br /> REVIEWE0 BY... <br /> ....A--------------......... -----­----------DATE.- <br /> .. ' <br /> BUILDING PERMIT ISSUED.-Jt..................................... .. .......................... 6 . ... ................ DATE.........._­-7,?�.......................................... <br /> • <br /> ... ......_.........................I.......................................................... <br /> Alterations and/or recommendafions:..__.......... .. .... <br /> ...............•... .........•••--..... . ..----.. .................................. 7' <br /> ................................................. ....... ...................... ..•••._......•------•••......•--......._....................................­­..................... <br /> ..........­..............................................................................................................................................­ <br /> .................:...................­­......... ....................................................­­.........................................­­........ ............................................ <br /> ....................... ......... ................. ............... <br /> ........................................................................................­...................... <br /> FINAL INSPECTION BY.-. II. ......wa_ ... Date...._ <br /> .. .... . ......... ........ <br /> ...7.............. ........ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American Street i 300 West Oak Street 132 Sycamore Street 814 North "C' Street <br /> Stockton, Californiaip Lodi, California Manteca, California Tracy, California <br /> .. <br /> ES-9-2M IC-52 Revised W-2100'i <br />