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i APPLICATION FOR SANITATION PERMIT Permit No..Vr.�It __ <br />" Vw (Complete in Duplicate) <br />Date Issued <br />li b made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />plicalion is hereby q <br />This application is made in compliance with County Ordinance . 549. <br />JOB ADDRESS AND LOC ION ----j' -- ----- --- - - - -- -j <br />,�trel� Phoned�i <br />Owners Name---------------------- - -�--------- ------ -------------------- <br />- -- <br />-------------------- <br />­k <br />---i-------•-- <br />Contractor's Name -------------- L� 1 _- --- - -----•-------------------------- Phon <br />Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [I Motel ❑ Other ❑ <br />/ <br />Number of living units: _ r-___ Number of bedrooms _go_ Number of baths __/.-. Lot size_� _i._--_7�_____�__x- 3r <br />Water Supply: Public system Community system El Private E] Depth to Water Table ',/At. <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9?"�ardpan ❑ <br />Previous Application Made: Yes ❑ No [jg�New Construction: Yes ❑ No ❑!//""�"'`'` <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Ta Distance from nearest well*W__ Distance from foundation -JO <br />______.Mat�rpial--.�C________-�"�+�.__.________.__. <br />[ No. of compartments___-t�..._.. Size_,+"�_rt--_,__.Liquid depth --- __dt.__N-------- Capacity._.._____ <br />Disposal Fi Id: Distance from nearest well- ��.. Distanceirom foundation ___-_f --------- Distance to nearest lot line__________. <br />[ Number of lines ___I______-_._. ___. Length of each line___ Width of trench ---,-'tom___`-______________ <br />l� -+i <br />Type of filter material-_�___�_�l�.__Depth of filter material ---- .��--------- Total iength__-Av________-_----. <br />Seep�ag/e �,iti Distance to nearest well_:Q�1.4_ Distanc fr, m f undationQ____.__.Distanc`r+o nearest lot line_________ <br />L� qq <br />Number of its.. Linin material-_-___.____ ___..Size: Diameter____+__.__-_ Depth_�rC�__________________ <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 building ___________________________---__-___._._. <br />❑ Distance to nearest lot line -------------------- ---------------------------_ ----------------------------------- ---------------------- -------------------------------- <br />I <br />Remodeling and/or repairing (describe): ---------------------------------------------------------------------- -----------------•---------------------------------------- ------------------ <br />--------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------- ----------------------------------- <br />------------------­- -------------------------------------------------------------------------------------------------------------------- ­ <br />-----------------------------------------•-----------------------------------------------------------•--•---------------------------•----------------------------------------.--•-------------------------•-•---------- -------------------------------------- <br />------------------------------------------------------------------------•-----------------•-----------•--------------------------------------;---------------------------------------------------------------------------- <br />I herebyify +hat I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, fS"-ajeelaws, and rules and regulations of the San Joaquin Local Health District. <br />{Signed]- ------------------------------------ ----------- F Contractor <br />-` <br />!''! {Title) <br />By:------------------------------------------------------------------ fC.Y� " --------- <br />(Plot plan, showing size of lot, location of system in relatin o wells, buildings, Ptc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATIONACCEPTED BY ------------- -----=-----------------------------------------------_---------------------- DATE----------- ------- --------------------------------- <br />REVIEWED BY------- DATE ------------------ - - <br />BUILDING PERMIT ISSUED ----------------------------- <br />--------------------------------------------------------------.. DATE------------------------------ --=-------------------------- <br />Alterations and/or recommendations-------------•---- �----•---------------------------------------------------------------------------•---------------�-- ---- ............. .------- <br />------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- .... .-------••------------------------------------------ <br />---------------------------------------------------------- ----------------------------------------------------------------------------- r •---------------•------------------------------------•-•-------------------- <br />FINAL INSPECTION BY:- ---- Date--'-- -J- ---o ---------- ---- --- -------------------- <br />130 South American Street <br />Stockton, California <br />ES -9-2M : Revised W-2100 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Lodi, California Manteca, California Tracy, California <br />