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0 O� -------------- <br /> APPLICATION FORS SANITATION PERMIT Permit No.-V� <br /> (complete in Duplicate) <br /> Date Issued <br /> A1 <br /> Application is reby made to the San Joaquin Local Health District for a permit to construct and install the work herein des&ibed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> BA <br /> ADDRESS AND:LOCA,TI ------------ ---------------!��----------- <br /> 0_�U� - ------ )I-------------------------------------------------- <br /> - <br /> Owner's Name------------------------------ -11- ---------------------r-------------------------------------------- Phone <br /> Address................---- --------------I----------- -------- <br /> -------------------------------------------------------------------------------------------------------- ------------------ <br /> 77- <br /> Contractor's Name-' ---------­ ------ <br /> --------------------- - - --------------------- ----------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence 0 Apartment House E] Commercial E] Trailer Court E] Motel F] Other n <br /> Number of living units: Number_-of,bedrooms.__A__.Number.of.baths -A---- Lo; size ---------;Z-0®____ _______6_a_---_______.__._ ' <br /> Water <br /> ------6-a--------------- <br /> Wafer Supply: Public, system E] Co' mmunity.systim Private F-1 Depth to Water Table _24_ ft. <br /> Character of soil to a depfhof 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay F] Adobe Hardpan El <br /> 11� 'rO <br /> Previous ApRlication Made:Yes E] No <br /> New Construction: YesNo ❑ <br /> ? t - <br /> TYPE OF INSTALLATIOW A zN"6--SPECIFICATIONS: <br /> (No septic tank or cesspool pe 6ifted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-------Y�---Distance from foundation-------14- -----Materiai'h--------- 4 <br /> mo -------- <br /> xNo. of compartments_-.________---- -------;.t-----------Size_----3-X 5__x Liquid de P �i - --------Capacity----- <br /> I <br /> Disposal Field: Distance.from nearest well..-____1N._.._.Distance from foundation--------�_1___Disfance to nearest lot line----dr..... <br /> IN Number 'o-ir -------------------Length of each line----------- of french-----------2-""' #ZA <br /> I - - - - --------------- <br /> Type of filter material-------- Depth of filter material---- ----Total length--------------J�2-r) 1 4 <br /> *Distance Pit: to nearesf',well----------------------Distance from Distance to nearest lot line_____-_.______.__ <br /> rn found6tibn--------- A <br /> F1 Number of pits--------I--------------Lining material-----_----------------.Size: Diameter-----------------------Depth.------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation... ----- ----------Lining material-_..____-_______._________.______.__ <br /> ❑ <br /> aterial------------------------------------- <br /> El Size: Diameter------- `----------------------------Depth----------------------------------------------------Liquid Capacity-------- •------------•--gals <br /> Privy: Distance from nearest well--.------------------------ ---------------------Dista'nce from nearest building____._.___-_-.__________________.___--.._ <br /> ❑ <br /> uilding----------__-------------------------- <br /> 0 Distance to nearest lot line <br /> Remodelingand/or repairing (describe)----------- -------------------------------------------------------------------------------------------................................................. <br /> * A m <br /> ------------1------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -----------------------------I---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------I- I L, <br /> -------------------------------:---------------------------------------------------------------------------------------------------------------------------------------------------- ------ <br /> I hereby certify that I have prepaired this application and that the work will be done in accordance with San Joaquin County <br /> `ordinances, State laws, and/ules and regulations of the San Joaquin Local Health District. <br /> (Signed)___- -' <br /> ----------- ------------------------------ -------------------------------------------------------------(Owner and/or Contractor) <br /> --------------------------- <br /> By: --•--------I-------------_------------ ----------------------------------------------------------(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 /> APPLICATION ACCEPTED BY---------------:-------------- ------------------------------------------------ DATE---------- <br /> ---- ---------------------------------------------------------- DATE----- ---� / <br /> REVIEWED BY--------------------------------------- ------ - -- <br /> - f --- -------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------•-------- ----- ­------------------------------------------------------- DATE--------------------------- --------------------- <br /> Alterations and/or recommendations:---.-- <br /> "--------------------- ----------------- ------------------------------------------------------------------------------------------------------ ---------------------­---------------------- <br /> ---------- <br /> IV--:-------------------------*-------­*--------------------------------------------------------------------------­­----------------------------------------------------------------------- <br /> ----------------- -------------------------------- ------ ----------------------------------- ------- ------------------------------------------ - ---- ----------- ---------------------------------------- <br /> --------------------- ------------------------- <br /> --- <br /> ..- ------------*-------------------- ------------------------------ -- ------------------------------------------------------ <br /> �? I- . <br /> --- -------------- --- <br /> FINAL INSPECTION BY:---------- Date---------------- ------- ---- <br /> ----------- -------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTKDISTRICT <br /> 130 South American Street 300 West Oak Street' *V ? <br /> ,132 lycarnore Street 814 North "C" Street <br /> Stockton, California 1-10ji, California Manteca, California Tracy, California <br /> ES-9-2M 10.52 Revised W-2100 <br />