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Permit No. <br /> �\ APPLICATION FOR SANITATION PERMIT �S-(---�"•- <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. 549. <br /> l . <br /> ---------------------------------------------------------------------------- <br /> JOB ADDRESS AND LOCATION--.i----0_3s------- (( ,.-----------.... <br /> �S} ------------------------- -------------------- --------------------- Phone <br /> Owner's Name L `----= -- b <br /> Address------------------Xy.. -------- -----R,a---------------------------------•---- .----•--- -------------------------------------------------------------- <br /> Contractor's Name------ ------ --- -- •----------- ------•--••� �:•-•------------ -------------------------•-----=--------•--- Phone_��----�_'__%�_�_�" <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1______ Number of bedrooms ___Z—_ Number of baths __l... Lot size ____�� _ ___ _ _.--_ <br /> Water Supply: Publicisystem � Community system ❑ Private ❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet: *Sand F] Gravel ❑ Sandy Loam ElClay Loam ElClay I] Adobe M Hardpan <br /> Previous Application Made: Yes E] No {j] New Construction: Yes'❑ No L&. _ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspoolpermitted if public sewer is available within 200 feet.) <br /> .. t Distance <br /> w.� __ - <br /> Septic Tank: Distance.� from nearest welL__+��_______Distance from foundation___ P--_-_.___.Material--____.__ ___W'�_a_�_.__.____- <br />� � No. of compartments-------- _-�__ <br /> --------------Size---- -X--�--sem_-�-�--Ld d <br /> iquiepth-----_-------------____--_Capacity--- ------ • <br /> Disposal Field: Distance from nearest well----4 _._._.Distance from foundation___.`.__ ---------Distance to nearest loft line_7_1�5_-..... <br /> Number.of lines____________ f_ rf ��je'n th of each line------- s_.Width of french______ _lei __________________ <br /> Type of filter material____ epth of filter material_____/S��______._Total length---------7��_______________________ <br /> Seepage Pit: -Distance to nearest well_.__________:.__-----_Distance from foundation--------------------Distance to nearest lot line________________ <br /> i ❑ Number of pits--------------_-------Lining material_--------------------Size; Diameter-------------------------Depth_-.._ --------------_____________ <br /> Cesspool: Distance from nearest well_'--------------Distance from foundation-----.--------------Lining material------------------------------------- <br /> ElSize: Diameter------ -------------------------------Depth-------------------- -----------------------------Liquid Capacity----------------------------gals. [. . <br /> Privy: Distance fromnearestwell---------s:`-----------------------------------Distance from nearest building----------------- -------------`-----:-. `N <br /> ❑ Distance to nearest lot line--------------------------'---------------------------------------------------------------------------------------=----------------------- <br /> I ' <br /> Remodeling and/or repairing (describe):----------------------------------------- <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, Sff a aws; and rults and regulations of the San Joaquin Local Health District. <br /> (Signed)---------- ------ -• r -- ----`--------- ----1--------------------------------------------------------I caner and/or Contractor) <br /> s , <br /> BY=-. -- ---- -•---- ..A „-- ------------------------ (Tale)---• --------------------------------------------- <br /> (Plot plan, showing size`of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY ----- ---------------------------------------•-------------- DATE------ >------------------------------------------------- <br /> REVIEWE <br /> ------------------------------------------------ <br /> REVIEWED BY----------------------------------- --------- ---- DATE ------------------------------------ <br /> ---------------- ---------------------------------------- <br /> BUILDINGPERMIT ISSUED - --------------------------------------------- DATE------- ---- --------- ---------------------------------- <br /> Alterations and/or recommendations-------------- ---- ----------- } <br /> - tj ------••- <br /> ---------------•-------•--•----- ---- <br /> ------------------•------------------------------------------------- •--------------------------------------------••---------------- •-------------------•-- -------------------------------------------------------------- <br /> 1 ---------------••-----•----------•-•----------•--------•------•------------------•-•---------------- ---------------------------------------------- -------------------------------------•----------------------------------- <br /> --------- ------------------------------- -------------------------•------------- ----------------- ---------------­-------------------------------------------------------------------------------------------------------- <br /> Z� <br /> FINAL INSPECTION ., ----------- Date —� . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S\ <br /> Stockton, California Lodi, California Manteca, California Tracy, Californi <br /> ES-9-2M Revised W-2100 <br />