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it <br /> APPLICATION FOR SANITATION PERMIT Permit No. ., -_d__.___.. <br /> (Complete in Duplicate) <br /> �I Date Issued <br /> IR <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 Nal. 549. <br /> I` , <br /> JOB ADDRESS AND LOCATION.----- -- <br /> .. �' ' '- <br /> Owner's Name--------- a ----? ---- 1 ----- ---- -j�----------------------------------------- Phone------------------------------------ <br /> -__: '4 �" <br /> Address._._. 'M - ---------- ---- <br /> --------- -- - ----- ------ ---- <br /> Contractor's Name--- ----- p &Z-`-- - Afif- _.-" ------ --- ----------•------------------- Phone <br /> 3 <br /> Installation will serve: Residence Apartment House ❑ Commercial '❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -- Number of bedrooms _. Number of b the 4--- Lot size ____--��� - ---- d- --------------------- <br /> :i�: '� <br /> Water Supply: Public system 'C] "Community system ❑ Private Depth to Water Table, 4r ft. <br /> Character of soil to a depth 'of 3 feet: Send ❑�Gravel ❑ Sandy Loam ❑okay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: Yes ❑ No [ New Construction: Yes u IJo ❑ t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank- Disfanceih <br /> No, of compartments 2from nearest wedll_� Distance from fo ation___P --------Mat rial___(7__ ___ ____________ _____-_-__ __ <br /> Sri .: __-Size.___v�'' rs.,c{. d d _ <br /> .Liquiepth _ ___ ------Capacity---- <br /> �f <br /> __ ___. <br /> Disposal Fief Distance from nearest well d._:_._.-Distance from foundation__ _ Distance to nearest lot.kin._�o------ <br /> P �,� p10, <br /> Number. of lines___-_!d�^'�/- �+ Length of each line_____._ "� Width of trench___.______ <br /> T e of filter material. ,_ _._�__- Depth of filter material____.__ `--____.____Total length_______ _• _______________________ <br /> YP ��. �,, ff _ / f <br /> Seepage Pit: Distance to nearest,well.I_70--------Distance from fo ndation_/X4--_____.D•stance to nearest lot line__l�/._--_____ <br /> [ � Number'tlof pits__,eQv _-_-.---Lining material—AC Diameter` ------------Depth_____, �_ � <br /> 1 <br /> Cesspool: Distance" from nearest well___._______.____Distance from foundation--------------------Lining material--.---------------------------------- <br /> Size: Diameter--!7"r7"----------- - t❑ Depth---------------------_-----------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from <br /> rom nearest well ________________-------------------_____________Distance from nearest building------___-___________________-__________. <br /> ❑ Distance to nearest lot <br /> II <br /> k <br /> line---------------! ----------------------------------------=--------•-------------------------------------•----------- <br /> Remodeling and/or ____. __ --____ __--. . <br /> 1� ' -- - ------------ -•---•-�''-- - -- - -- -- <br /> __ 4 •---- --�--- ---- <br /> -------- ------- - _ l - -- .. a�- ---• - - ----•-------------------5�. _.. = <br /> ---------- - • -------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Safi Joaquin County <br /> ordinances, State laws, nd,rules and r, ulations of the San oaquin Local Health Dis ict. <br /> (Signed) _...__ �(�. ��A <br /> ---- .. ----------. LOwn an, or Contractor)= � <br /> B ' ----------------------------------------=--------------------(Title) ------------------------------ ---------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> _ <br /> f FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEDI'BY------------------------------------------ ----- L - ---j�- DATE-•---------- � —�C <br /> REVIEWED BY /�j DATE. <br /> -------------��-------------- ------- ----- -------------------------- ------- --- ------------------------------- ----------------------------- <br /> BUILDINGPERMIT ISSUE6---------------------------------- ---------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations-------------------------------------------------------------------•--------------•------------•-•----------------------------------------•------.--_--------- <br /> il •----------------------•--------------•--------------------------------------------------•---------- <br /> -----------------•----------•----------- ------------------------------------------.----------------- <br /> ----------- il <br /> I <br /> FINAL INSPECTION BYi- ------ Date-------- <br /> � - --�' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 11 <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California II Lodi, California Manteca, California Tracy, California <br /> 11 <br /> ES-9-2M ; Revised W-2I100 <br />