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--- <br /> S� - <br /> APPLICATION FOR SANITATION PERMITPermit No. ----- <br /> �- <br /> (Complete in Duplicate) <br /> Date issued ---------Z�-^j-� <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 Ordi ante No. 549. �J � <br /> JOB ADDRESS AND L CATION...---- f - ---- ----------- ` 1-1 - ----------- -1 ----------------------------- <br /> /�� !_I_-�� _/1Q- /__�. ----------------- ---------- Phonel,�'�_ -'4L�ara <br /> Owners Name-------L �[�� . i -------i- <br /> Address-------• ..-1------ --------------------------------------------•-------------------------------....--------------••-------------------------- -----•-----•------- <br /> Contractor's Name--------------- <br /> --,-0� ---------------•-----•--•------•------------- Phone//Z�"LIC"--� <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: J___ Number of bedrooms -- Number of baths _ - Lot size ____ -x____/S-r_________ <br /> ________________ <br /> Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table ZJ9 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe r-71 Hardpan ❑ ` <br /> Previous Application Made: Yes ❑ No�41 New Construction: Yes ❑ No [� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank- Distance from nearest well-----------------Distance from foundation-----------_--------Material______._____._____---_.._____-._________..______. <br /> ❑ No. of compartments----- - -----------------Size--------------------------------Liquid depth--------------------------Capacity------ ---------------- <br /> . � 1 <br /> Disposal Field: Distance from nearest well_4—t-__-Distance from foundation_/.-O----------Distance to nearest lot line... <br /> Len th of each line______ --- Width of trench_.-_ -______________- <br /> Number of lines___�i?'L --' -------- -- g i r� <br /> Type or filter matenal_ ;�_-f2PN14_-Depth of filter material------l-9-----------Total length______7..-s--_____________________._ <br /> Seepage Pit:,,_ Distance to nearest well------,--------------Distance from foundation-----------_--------Distance to nearest lot line_________._____ <br /> ❑ xtty� Number of pits----------------------Lining material---------------------.-Size: Diameter------------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----- --------------Lining materia!-----_-----_________.____-__ _____. <br /> 1771 Size: Diameter--------------------------------------Depth-------------- -------------------------------------Liquid Capacity--------------- ----- 9als. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------.------------- <br /> ❑ Distance to nearest lot line------- - ----------------- ------------------- ----------------- --------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe :---------- -,-'-------,.-w-- --- °`----•------• <br /> -------------------------------------------------------------------I---------------- --- <br /> ------------------------- ------ -------------------------------------- <br /> ----------•--------•------------------ -----------------------..-------••--------•--.-----------------------• <br /> - ------------------------------------•-.------ <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, State,lawls;-and r les and regulations of the San Joaquin Local Health District. <br /> _. _._ Owner and/pr Contractor <br /> [Signed} 1 / /s / , - --------- C <br /> ( / I <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> `5 <br /> APPLICATION ACCEPTED BY------------------------ ..d -------------------------------------------------- <br /> ------------------------------------------------ DATE 1 <br /> REVIEWED BY ------------------- DATE---•-----------------------•-------------------------------- <br /> ------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------- ------ DATE----------------------------------- ------------------------ <br /> AltrerIl�ions a_nd �rnco._m <br /> ndations � <br /> ---- ------ <br /> ,c„ - -- - <br /> ,-. - ----- <br /> -------­-------- <br /> ----------- <br /> --- • - - ,- <br /> ! - - ------ � - -------------------------------------- <br /> --------------------------- <br /> FINAL INSPECTION BY:------------ I ----------- ----- ------------- Date----- _ hf -° - -' <br /> ------------------ <br /> �s I <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 /> SES-9-2M ; Revised W-2100 <br />