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T <br /> 1 APPLICATION FOR! SANITATION PERMIT <br /> Permit No. .. -z -------••- <br /> (Complete:in Duplicate) Date Issued <br /> is hereb made to the San Joaquin LocalHealth District for a permitto construct and install the work herein described. <br /> ?%pplica4ionY <br /> nce with County Ordinance No..549. <br /> This application is made,in compliaw I' <br /> JOB ADDRESS AND L ATION..' <br /> -------- --------- t sY� � <br /> Phone_ �f <br /> t ?ter - ----------------------- --------- <br />► Owners Name.--------- ----------- � -- ..--.. - <br /> --------------------•------------------- <br /> Address-------------- <br /> ------Address------------•- ---------- -- - ------ - - <br /> i <br /> -=---------�-- ---------•-------- --------- --------•-•----- Phone <br /> Contractor's Name___----.- 4 <br /> Trailer Court Motel �] Other ❑ <br /> Installation will serve: Residence Apar-mei House ❑ Commeru}I ❑ ❑ <br /> �A -- <br /> Number of living units: __/-___ Number of bedrooms - --- Number of baths ___. Lot size ______ _-- -- <br /> Private Depth to Water Table �f+- <br /> Water Supply: Public system Community Isystem ❑ I ❑ I P l i <br /> Character of soil to a depth of 3 feet: Sand,❑ Gravel ❑ °i andy Loam ❑ Clay roam ❑ Clay ❑ Adobe Hardpan ❑ <br /> { Previous Application Made: Yes ❑ No New Construction: Yes .No ❑ <br /> I ,a 1 <br /> TYPE OF INSTALLATION AND SPECIFICA`�lONS: <br /> C No septic tank or,cess ool ermitted.if., ublic sewer is;avadable within 280 feet.) <br /> ( P p P p .1F , r <br /> { Septic Tank: Distance from nearest well`• _.__ -__.__Distance from�found�tion_�D_______--.Mater'al__� s_____ .---- <br /> d� <br /> • Li uid depth .7------'---Capacity_-- ------ <br /> No. of compartments----- - ------------- t4-- `-- --- ---- q <br /> i <br /> Disposal Field: Distance from nearest well{ ___________Distance from foundation--------------------Distance to nearest lot line.______..__:_..__ <br /> Number of lines----------- ---- --- `----------Length of each line_.---------------------------Width of trench----------------------------------- <br /> ❑ Type of filter rnateria4------- ---------------Depth of filter material------------------ ----Total length---------------•---•----------- O <br /> y" Distance from fo dation___ _l_....... to nearest lot line_________________ <br /> Seepage Pit:—' Distance'to nearest well/r'+-fly--'�- ;, �. Depth______-- �� aq�( Number of pits.------/-------------Lining mat ervaL _ -- _ _---Size: Diameter__-_- - <br /> CesspooLI H Distance framI nearest well_________________Distance from foundation._---.__.._-------Lining material------------------------ ------- <br /> + -Liquid Capacity gals. <br /> ❑ Size: Diameter`--------------------------------------Dept:h_-----------------t---------- --------- <br /> -_-____Distance from nearest building <br /> # Distance from nearest well----------------------- ' - -- ----- --- ------------------- <br /> Priv ------ -❑ Distance-to nearest let line___-----------------------------------'-------------------------------------------- 9 <br /> T ----------------------•-----•------------------------------------------------- <br /> Remodeling and/or repairing (describe :------,pe- <br /> i --•--'------•--------- -------------•--------r--------:------------------ <br /> l ` ---------•-------------------- -------------- <br /> Ei <br /> I hereby.certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, State laws; and rules land re ulations of the San' Joaquin Local Health District. <br /> -- ----- <br /> k ----- <br /> (Signed) <br /> ------------ --(Owner and/or Contractor) <br /> (Si ned - ----- " <br /> g t �I ---k--------------- <br /> By:_... �.. ---- <br /> I ` (Title _ G <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be ed on reverseYsid" <br /> ¢ FOR DEPARTMENT USE ONLY <br /> I - DATE---------- I� ----------- --- <br /> I APPLICATION ACCEPTED BY 11 •-- DATE---- ----------------------------------- <br /> REVIEWED BY__.--------•--------- --------'----------.-.- ------------------------------------------------ BATE <br /> 6., ' - -4 <br /> BUILDING-,PERMIT-ISSUED-------- -- -----=_----'ry------ - <br /> Alterations and/or recommendations--------------------------------------I-------------------------------------------------------------­ <br /> -------I-IL- <br /> ---------------------------------- <br /> ------------------------------•--.--------------- ----------`------------- <br /> ----------------•--------- ----------------------- <br /> ---- ----- <br /> . Il -`-s------------------',--. <br /> --- ---------)€- <br /> '- --------- Date ---------------•--------------- ------------------------------------------ <br /> FINAL INSPECTION BY: ----------"-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ! {32 Sycamore Street 814 North "C" Street <br /> 130 South American Street 300 West Oak Street . Trac California <br /> w <br /> Stockton, California Lodi, California Manteca, California y <br /> FS--9-2M ; Revised W-2100 <br />