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Y6 -- - <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._, ---- <br /> (Complete in Duplicate) Date issued _6A <br /> 2-4 01pplicafion isereby made to the Son Joaquin LocalEmit iescribed. <br /> Health District for a permit to construct install the work <br /> work <br /> ... h <br /> "lis application ismade in compliance with County Ordinance No. 549. <br /> ---------- - --- --------- ------- <br /> JOB -ADDRESS AND LOC ho <br /> TION_.__-- <br /> Name_______ %,X11P --------- ------- - - - - --------------- ---- ------------------------ ------------ Phone- y---------------- <br /> ---------------------I----------- ------------------------ <br /> --- ---------------------------------------------- <br /> -- -------- ­ -- <br /> Address----_------------------ "--/ -.11 - Phone-- - ---- <br /> Contractor's Name---- ------- -- - -------:%----------------------------------------- ,L,-, <br /> Installation will serve: 1�Residence Apartment House 0 Commercial [] Trailer Court 0' Motel 0 Other El <br /> Number of bedrooms Number of baths ,I. Lot size ----I/012_- lea---- ------------------ ----- <br /> Number of living �It o Water Table '" t. <br /> Water Supply: Public system D Community system [I PrivateX Depth t <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam E] Clay Loam 0 Clay E] Adobe Hardpan <br /> ❑ <br /> Previous Application Made: Yes E] No)Z� New Construction: Yes)e No 0 <br /> TYPE OF INSTALLATION AND SPECT CATIONS; <br /> (No septic tank or cesspool permitted if public sewer is available within'ti200 feet.) <br /> e from fou'�aatjon-------------------rMaterial------------------------------------ ------------ <br /> Septic ank: Distance from nearest well_________--------Distance --------------------------- <br /> Nb. of compartments_-----------------------Size...I---------------- ------------Liquid depth Capacity...... ----------- <br /> V <br /> Dispo IField ---------- ance Distance from nearest well------ Distfrom foundation--------------------Distance to nearest lot line_____________...- <br /> ' Width of trench.-------------------------- <br /> e <br /> rench.--------------------------------- <br /> Number of lines-----7:�_-_:----------- -------Length of each li,ne------------------------------ <br /> I --------Total length-----------------------------•------------ Z, <br /> rial------- material QT' filter material.______- h j filter mifer�a 4�/ <br /> e*lyt linp/-- ------ <br /> C fr <br /> `Seepage Pit: Distance to nearest well_- e om f4un at ---- <br /> %D d ion--,/0..........Distance to near <br /> P ------ <br /> Number of pits--.;---------------Lining material _Size- Diameter___" -----------------De ------ <br /> Z St. <br /> c fro o atio ------------------- Lining material--------------------- <br /> esspool: Distance from nearest well_______ Distance r Im ------__Li quid Capacity--------:--------______.__gals. <br /> Size:-Diameter---------------------- ---------------Depth--------------------------------------------- <br /> El1 <br /> Distance from nearest building-------------------- ..... ----------- <br /> ---------------- <br /> Dis�ance from nearest well---- ----------------------------- 1 11 <br /> Privy:- rest lot line----- ---- ------------- -- -------------------------- <br /> -Distance to nea ----------- -------------------------11 <br /> n Z - ------------------ <br /> -- -- --------- --- ----- ---- <br /> Remodeling and/or repairing �w---------------------------- <br /> es ------------------- <br /> --------------------------- --------------------- <br /> ---------------------------------- ------------- ---------------------------------------------------- ------- ---------------- <br /> ---- -------- <br /> ----------------- <br /> ----------------------------------------------------------------------------------------------------------------------- --- <br /> -----ell-2 ------------------------------------------------------------------------------- ------------ <br /> ------------------------ --------- ---------------------------------------------------- <br /> --------------------- Joaquin County <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 law;, and rul sa d regulations of the San Joaquin Local Health District. <br /> [Signed)--- ---- ------- ---- --------- -----------------------------I---------------------------------------------------(Owner and/or Contractor) <br /> --------------------(Title)- �t-F*-- ----------- - ----------------- <br /> - <br /> By:- ---------------- --------� _7--- ------- - ---- - - ------------------------------------- -j <br /> (Plot plan. showing size of ot. 10 afion of s stem in relation to wells, buildings, etc., can be placed on reverse siee. <br /> FOR DEPARTMENT USE ONLY <br /> DATE----------------- --- ----- --------------------------- <br /> APPLICATION ACCEPTED BY--------- ------- - ------- --------------------------------------------------------------- <br /> - RATE_ -------- _��-- - --- ------------------ <br /> REVIEWEDBY----- ------------------------------------ ------------ ------------------- -- --------------------- <br /> BUILDING PERMIT ISSUED__-____---"------- ------- ---- ------d--------- DATE-- <br /> Alterations and/or recommendation ----- --- - --- ------- -------------- <br /> ---- ------- <br /> --------------------- -- -------------------- ----- ---- --- ------ ------- -------------- ----- <br /> ------------------------------------- <br /> ------ - --- --- <br /> ---- ----- ---------- ........ <br /> ,.'FINAL INSPECTION 'BY:----- ---C71WI.-C--------- ------------- ---------- Date- ----------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street <br /> TracCalifornia <br /> Stockton, California Lodi, California Manteca. California y, <br /> P5-9-2M 1c-52 Revised W-2100 <br />