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Permit No <br /> AP ` l v <br /> PLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Date Issued _______________________ <br /> Applica{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. 5649. M <br /> JOB ADDRESS AND OCATIO ---- 'L-t ce,-- o -Q"- Q E 1--i-�t�-� <br /> -_. _ . -------------- <br /> C <br /> _---._ Phone-1//W---- <br /> Owner's Name------------ &rv---•- ------------------------------•----------------- --- --------------- n <br /> Address--------- ------------4...-• -------.--------------- --------------- --------------------------------------2h--a-_f-{=--_,-- <br /> �--- <br /> Contractor's Name--------------------------------- ------------ ------------------•--------------------------••--- Phone _... E'Q � <br /> Installation will serve: Residence D--A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --/___ Number of bedrooms Zk__ Number of baths -_/___ Lot size __���_i4____�__�_-�--------------------- <br /> Water Supply: . Public system [Community system ❑ Private ❑ Depth to Water Table *ft. <br /> Character of soil to a depth of 3 feet: Sand PGravel ❑ Sandy Loam ❑ ..Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No e New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest well—t+0118__Distance from foundation-J-0./---------Material------ <br /> No. of compartments---P11-------------------Size_a-z" _ __ -" Liquid depth___�9f'---------Capacity_Ee <br /> � __ __.___• <br /> "'--'-.----Distance <br /> Disposal KQ& Distance from nearest well-90fle____Distance from foundion-1-0- to nearest lot <br /> Number of lines----I------------------------------Length of each line_-3-D?---.----------_-Width of trench--- - -t <------------------ <br /> Type of filter material hk......Depth of filter material--__!_&_'�.-_______Total length_-_ ----------------------------- <br /> --------- l <br /> Seepag Pit: Distance to nearest from foundation_-_A_ e_�.._.___.Di �e to nearest lot lin ___. ___.__ <br /> Number of pits______--------------Lining mate Size: sta�n Diameter__-___Zi-' -________.Depth----A_r________________-_ <br /> Cesspool: Distance from nearest well-T � _ __Distancfrom foundation_____--------------Lining material--------------------------------------- <br /> Size: Diameter-------------------------------------Depth-_e--------------� - -------------- --------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------- Distance from nearest building____-----____________________._______--_ <br /> ❑ Distance to nearest,lot line---------------------------- --------------------------------•-•---------------------------------------------------- --------- W <br /> Remodeling and/or repairing (describe):-----------------------------------------------------•---•-----•---------------------------------------------------------------------------------------- <br /> _ �a <br /> -----------••••--------------------•----------------------------------------------- ------------------------------------------•----------------------------- <br /> ---- p <br /> ---------------------------------------------------_.........__....- --- <br /> ----- -- ------------------------------=---------------------------------------------------------•------•------------------------------------------------------------------------- ------------------------------------- <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, Sta�, and rules and regulations the Sart Joaquin Local Health District. # . <br /> (Signed]...............k ---c h;.�-�----------�-•n=---------- ---- -------------------------------------- w° Contractor) <br /> --- <br /> By:.... - ----- ---- <br /> (Title)-- <br /> (Plot plan, showing size of lot, location of system in r ation wells, buildin , e c., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--------------------- --- - -------- ----------------------------------------- •--- _ DATE-----"5- �'.---------- --------------------------------- <br /> REVIEWEDBY - -- -- ---•--- --------------------------•-------------------------------------- DATE- <br /> BUILDING PERMIT ISSUED ------- -------- DATE 4 ;� <br /> Alterations and/or recommendations:--•------------------------------------rl --------••----------------- <br /> --------------------------------- ---------•--------------•---------------------• ----------•---------------------------------- -------- ......... <br /> -------------------------------------------------------------------------------------------------------------------•---------- ----------------------------------------------------------------------------------------------- <br /> --------------------- ---- ----------•-------------------- --------------- -----------------------------------•--------------------------------------•--------------------------------- <br /> = --------------------------------•------------------------------I-------- --------------------------- <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 /> RA ;­d YY-210 <br />