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APPLICATION FOR SANITATION PERMIT Permit No. _. 3 <br /> y.z 3 <br /> ........... <br /> (Complete in Duplicate) Date Issued ---- <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance wit Count Ordinance No 649 -,f e_7-7,7c'r" <br /> TS <br /> 10 .. <br /> JOB ADDRESS AN ------- ------- ----------------------- <br /> .A LOCATIO <br /> Owner's Name---a��--- --- - ----- ------------ ------- Phone------------------------------------ <br /> *--------•-- ---------------- ------------------------------------------- <br /> Address............Pi-0-A--...6-,P-4.....L- Y--------------ir-4L--s-_-_-e-4--—------—----------------­-­­----------------------------------------------------------------------- <br /> Contractor's Name----4�?. . ------(?-.tm--------- ------------------------ <br /> Installation will serve- Residence X Apartment House E] Commercial [j Trailer Court El Motel Ej Other [I <br /> Number of living units: .-I--- Number of bedrooms ..2— Number of baths ./--- Lot size ---- __-x__-/_ _n__ ------------------ <br /> Water Supply: Public system JX Community system C] Private F1 Depth to Wafer Table <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam X Clay El Adobe El Hardpan El <br /> Previous Application Made: Yes [] NOA New Construction: Yes 9;--No 0 <br /> TWE OF INSTALLATION AND SPECIFICATIONS: <br /> I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest istance from foundation----JA0..r'___.Maferial....Cl.;-� ------- ------------------ <br /> I <br /> No. of compartments---------">.........Size_-SXj?_A_4------Liquid clep�h------4-----------------Capacity---R-0-0-------- <br /> Disposal Field: Distance from nearest well__.7k-r-_-t-Er1stance from foundation-----1�-1-1----Distance to nearest lot line-----Is-.,---- <br /> Number of lines_____________/----------I--,e---- ----Length of each line-----------A q...........Width of french-----2-_*_,I------------------- <br /> Type of filter material---1_„ -------------Depth of filter material-----/-Z-----------Total length--------4-0......1------------------- <br /> Seepage- Pit: Distance to nearest well......7wq-14— <br /> ----------------Distance from founclation------/P... Distance to nearest lot iine-----07------- <br /> Number of P'tS-7—---/-----------Lining maferial___494Ar4----Size: Diameter___ 2 Depth___.__7_0---------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining.material______..______-_--______: <br /> ----------- <br /> ❑l �: Sizo: <br /> aterial------------------------------------- <br /> 0Sizo: Diameter------------ -------- ------- --------Depfh-----------------------------------I-----------------Liquid Capacity-.-------------------- ----gals. <br /> Privy: Distance from nearest"Well---------------------------------------------- -Disfaric' <br /> e from neareO building----- --------------------------------- <br /> Distance to nearest lot line.-.'------ ----------------- ------ --------------------------•------------------------- - <br /> r -Remodeling <br /> ----------------------I----------------------------- <br /> -Remodeling and/or repairing (describe),---------------------------------------------------------------------------------------------------------------------------------------- --- <br /> ---- ------------- <br /> ; <br /> ------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------:--------------------------------------------------------*11*1--------I--------------I---------------I--------------------I--------- <br /> ----------------------------------------------------------------w----------­­------------------­­------------------------------------------------------------------------------------------------------------Z---------- <br /> I hereby certify that.I have:prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules-and regulations of the San Joaquin Local Health District. <br /> {Signed)_._ - --------- ------------------------------------------------ti�� Contractor) <br /> By- -----------------------------------------------------------------------{Title]- .Q, ------- ---- ---- ------ <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 /> 4_ -----I - —S--%-------------------------- <br /> REVIEWED BY------------ <br /> ------------------ ---------- - ---------------- _....------------------------------------------ DATE------------I--------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE <br /> Alterationsand/or recommendations:--------------------------------------------------------------- ........... -------------------------------------------------------------------------------- <br /> -------------­_­------------- ----------------------------------------------------------------------------------------------------------------------------------------------------_------------------------------------ <br /> ------------------------------------------------------------------------ - -------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- -----------------------•------------ <br /> s <br /> --------------------------------- <br /> I--------------------------------------------------------------- ----------------­ -1--------------------------------------------------- <br /> BY:,-- ------------- - ---------- - <br /> ---- - -------- <br /> FINAL INSPECTION Date-------- - -------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American Sfreef 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Streef <br /> 11orklon, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />