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APPLICATION FOR SANITATION PERMIT Permit No. , --7_A..- y{ <br /> (Complete in Duplicate) <br /> Date Issued _��/[��-� <br /> Application is hereby made to 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 /> yy ------ ----- . <br /> J`OB ADDRESS AND LOCATION/� ---�o-- -- �'�_�'�---g-��--�°-�'---- --�--��'°-- .�'•r�--------�--+----- <br /> Owner's Name r�- !_-� '4±• �� ----- - ----- ---- Phone f tl-f - <br /> Contractors Name_ ll'!P_Y_ 'YEI �,m;_ °if Y`__ _ �....Q = ---------------- Phone----- -----�----- <br /> .Installation will serve: Residence eApartment House ❑ Commercial ❑ Trailer Court [71 Motel ❑ Other ❑ <br /> Number of living units:/--__ Number of bedrooms ___QeNumber of baths ___:_-_ Lot size __ ____ _____"/077'1__ __________________ <br /> Water Supply: Public system ❑ Community system ❑ Private RbyDepth to Water Table_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam R<Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No F' New Construction. Yes ❑ No r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ,/A <br /> No septic tank or cesspool- ermitted_if.public-sewer_is-available within 200 feet.)- - <br /> Septic Tank: Distance from nearest well_4_±l-0,-__Distance from foundat;P -'4 <br /> n_ " a-____ _.M terial-�-�. <br /> ET No. of compartments-----_ ---------------Size_r��-r� ��=X-`�-Liquid depth__---1-�------------Capacity_ire,7P--- <br /> Disposal Field: Distance from nearest well,0­�____-Distance from foundation__.-f/al'---_-___Distance to nearest lot line_/ _--.---_ <br /> ®/ Number of lines__________ ----------------Length of each line--------`�--------------..Width of trench__-- _ _ <br /> Type of filter material- <br /> yp - �-t-+z__-___bepth of filter material-------- ___Total length_______ _V__,___�".' __�__ � <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation-------------------.Distance to nearest lot line____.,--__,_____ <br /> E] Number of pits----------------------Lining material-----------------_-----Size: Diameter-----1-----------------.Depth---------------------------------Ic- <br /> Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-------------------------------------- <br /> ❑ Size: Diameter----------------- --- Depth ---- --------- ---- -----Liquid YCapacity----------------------------gals. . <br /> = n' e'from nea est b ldE g <br /> Privy: Distance from nearest well -- -_ ______ __ __ ____ ista u, n ______" <br /> ElDistance to nearest lot line---------------------------------------- -- ------------------- ' -------- ------ --- ----------- <br /> t <br /> f� <br /> Rem�yodeling nd/or repairing (descrijbe}:__� �- "g_�fi °OF... �s"�"` 'p� -------- <br /> / �I"Yf ---a c.1-•--•--`-r�'�-�-a--�'----------- <br /> �6 A - _ ti.l fi '.'Y`-.�', -�-y?"E.,�;. "r ---- r�-P-'--yy�,�� ! b.�a�.........._. .� <br /> �( 7- ------------------------------------------------------ <br /> ---------------•------------------------------------- ------------------------- <br /> hereby ce.4-ify`tha`t I have prepared this application and that the work will be done.in accordance with San Joaquin County <br /> ordinances, Sate laws, prid rules Ad regulations of the San Joaquin Local Health District. <br /> [Signed} f _ .. � '`.._ ~ " --------"------------------------ ---------------(Owner and/or Contractor) <br /> B . _---_ - --- ---=--------------- = -------------------------_------.-__---- <br /> _ ._ �-�"� ----[Title)_�",<_��. <br /> (Plot plan, showin f 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 l � �--------------------------------------------- DATE—__­t;---------- = -- --- � �`.. <br /> REVIEWEDBY---------------------------- -------- ---------------------------------------------------- DATE ---------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------.-- DATE------------------------------------------------------------ <br /> Alterationsand/or recommend ations------------------------------------------------------------------------------------------------------------------------ -------------------------------------- <br /> -------------------------------•------------------------------------------------ •---------------------------------------•----------------------------------------------------------------------------------------------- .. <br /> ----------------------------------------------------------------------------------------------- -----------•-----•---------------------- --------------------------••----------------------_-----------------------.--- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------- --------------------------- <br /> e - <br /> ----------------------------------------------------------••-------- -------_------------------------------------------------------------------------------------------------------ ---------- <br /> FINAL;INSPECTION. BY- ---- ------ ----------------------------------- ------------ Date-------------/'----------/-------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT } `` <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />