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f7 <br />APPLICATION FOR SANITATION PERMIT Permit No. <br />(Complete in Duplicated <br />• Date Issue'd <br />Applic&ion 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 />JOB ADDRESS AND LOCATION___�_�-�j <br />1 -------------------------------------------------------------------- --------------------------- <br />Owner's Name ----------------- Phone --- S_�=34" <br />Address -------- <br />a <br />---=------ ---------------- <br />Contractor's <br />Z � ;---------------------------------------------- ------ Phone --- <br />Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E]ddMotel E]Otfer ❑ <br />Number of living units: _ �- Number of bedrooms _ �---_ Number of baths Lot size.: <br />Water Supply: Public system Community system ❑ -Private I] Depth to -Water Table -------- ft. <br />. <br />Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br />Previous Application Made., Yes ❑ No EL New Construction: YesX No ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: r <br />(No septic Tank or cesspool permitte i publics wet 's avavi�la.b�le;wifhir4 feet.) <br />Septic Tank: Distance from realest we __________Distance fror9S faundation__.�-4f______.... <br />Ma erial___ -L. 0Q <br />A No. of compe ments.-._:�.-------t..__-Size-_�X_3_X�____-___Li Liquid de th______ ____________ _` <br />`` q P Capacity <br />Disposal Field: Distance from nearest well --b0--..... Distance from foundation__ -0 ---___.Distance to nearest lot line f Q_---_____ <br />Number of line`s:........ <br />z -------- _______ Length of each line ------- Width of trench_____ Z �--- <br />_� ---------------- <br />Type of filter material--c:__%Qac Depth of filter material --._1- ---______._ <br />__Total length a ••-- L>J <br />Seepage Pit: Distance to nearest well ---------------------- Distance from foundation --- ..---------------Distance to nearest lot line: ---------------- <br />El Number of pits ---------------------- Lining materia l------............. <br />_-_Size: Diameter ------------------------ Depth ------ :------------- <br />F Cesspool: Distance from nearest well ----------------- Distance from foundation ----------------- a <br />`Lining material-._._-_____'____________-.-___________. ��qq <br />1 ❑ Size: Diameter-------------------------- - -------- Depth -------------------------------------------- Liquid Capacity --------- ,---------------- --gals.`!' ' <br />Privy: Distance from nearest well_________________________________.______ -______Distance from nearest building_________.___._ <br />y.__________•___----------. •. <br />❑ Distance to nearest lot line 7 <br />- <br />----------------------- - / <br />-I 5 i <br />Remodeling 'and/or repairing {describe):---------------- ------------------ ------• ---------- .----------------------------------- <br />------------- <br />-------------------- --------------------------- ------ ----------•-------------------------------•-----•----------------•-----------------------------------------------------•-------='------------ ------ . <br />r-------------------------------------------------------- '-------------------------------------------------------•------ --------------------------------------•----------!-------------------------- <br />--------------- ­­ ------------- <br />------------------------------------------------------------------ I <br />-------------------------- <br />I hereby certify that l 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 />d <br />(Signed)---_-- -------------------------------------------------------------------------------------------(Owner and/or Contractor) <br />iI <br />By: ------------------------------------------------------------------------------------------(Title)--•------- ----------------•--------- <br />(Piot plan, showing size of lot, location of system in relation +to wells, buildings, etc., can be placed on reverse side)., <br />f <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY------------ DATE.. <br />----- --- -=-- ---- -- -- ------ ----- <br />REVlEWED BY ------------------------------------- DATE = �� <br />BUILDING PERMIT ISSUED ------------------------------------------------------------------------------------------------------ DATE------------------- _ <br />Alterations and/or recommendations:--------------=---- -- ---------------------------------------------------•------------- <br />-•------- <br />--•--------------------------------------•-------_.------------------------------------------------------••----------------- - <br />I <br />•-•----------------------------------------------------'------------------------------------------------------ ------------------------------------- _ ----- - -------------------i <br />------------------- ----- -.------------------------------------------------- - <br />FINAL. INSPECTION BY: Ak_)- Date ------ ----- /.---~-- `----------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />k <br />130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Stockton, California Lodi, California Manfeca,,,California Tracy, California <br />ES -9-2M ; Revised W-2100 <br />