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-APPLICATION FOR SANITATION PERMIT Permit No.c .•-J-_.? <br /> ----- <br /> k (Complete'in Duplicate) Date Issued. _- S <br /> Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h rein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> rd <br /> JOBADDRESS AND LOCATION4r_------ - -------------------------------------------------------------------•-•------------ <br /> Owner s Name------------r--=-•----h-�----- • ------------------------------------------- -------------- ---.-- Phene__�---3� -741Z - <br /> t <br /> J R <br /> Address---------- �.. ----------------------- ------------------------------------------------- <br /> _� .,_ _, one 7�•--�� � !Jr 4---- <br /> Contractor's Name-------------- --- ------------ --------------------- = Ph Lam' 7 <br /> g to <br /> Instailation will serve: Residence Er�Aparfinent House ❑ Commercial ❑ Trailer Court. ❑ Motel ❑ Other ❑ <br /> Number of living units: - -- Number of bedroom-s -1--. Number of baths --/-- Lot s ze --= SD'Ir- ---------------------- <br /> Water Supply: Public:sysferii'Comm unity system h❑ Private ❑ DepthTto Wafer T6ble`-.;9' ft. <br /> Character,of soil to a depth of 3 feet: Sand [I Gravel ❑ Sandy Loam El Clay Loam E] Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No,E <New,Construction: Yes g-1,lo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: # <br /> (No septic tank'or cesspool permitted if public sewer is available within 200 feet:) <br /> Septic Ta k: Distance from nearest well-���__Distance f om foundation---- �_�--€-.Material_--�--�--- -------------------------- <br /> No. of compartments --- - __ _ ' I fze-_S G�C4/o'_--__^Li Liquid de th_--_-y-- ---- Capacity <br /> d� <br /> Disposal Field: Distance from nearest well_77A-----____,.Distance from foundati n--- v-----1--.Distance to nearest Igt line__~5---.__..._- <br /> Number of lines-------1------------------ � ] •• .r <br /> �/---_-:Length of,ea�h line---: --Q-----_��---_-).-.Width of trench------ � <br /> Type of filter material.--Si--f Os --.-_D.epth of fiIfer material--_l9___-_---I--Total length--_.--6'Q---__-_ <br /> ------ 4 <br /> Seepage Pit: - Distance to Feafesf well--------------_------Distance from foundation----------------- to nearest lot lin-e----------------- <br /> ❑ NuFmber of pits.------.:--I____------Lining material--._--_:---)-----------Size: Diameter---------------------Depth------------------..------------- V1 <br /> i ♦ �� <br /> Cesspool: Distance from nearest well__--------------Distance from foundation---------------- --.Lining material.-.----.- -----_----_----_--------. <br /> ❑ Size: Diameter t °= .Depth ----------------------- Liquid Capacity--------------- gals. <br /> Privy:` Distance from nearest well----------------------------------------------_-Distance from nearest building------------------------------------------ <br /> Distance Distance to nearest lot line y d <br /> ------------------------------------------------- -----=------ <br /> Remodeling and/or repairing (describe -------------------------------------- ------------------••----------------- = = � <br /> 11 <br /> --------------------------------------------- -----------------------------------••------------------•--•---------- ------------------.-....-_.•--------------------------------•-----------------------------------` <br /> r <br /> ---------------------------------------I-------•------------------------------------------------•---------------•-•---------------I.......---•---------•-•--------------------------------------------------------------------- <br /> . , .I ¢ <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> # _ - C_ ------- (O ner and/or Contractor) <br /> (Signed)------ f --------- ---,-(-�-- <br /> BY� ---------- -- --------------------------- -----(Title} •Gt/C <br /> (Plot plan, showing size'of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--- -------------------- -•----------------------------------•--------- DATE---1----------------------------------------------------• <br /> REVIEWEDBY------------- --------------------- --------------- --------------------- ------------•----------------------------- DATE-,C- - . <br /> BUILDING PERMIT ISSUED----------------- -- <br /> ------------------------------------------•--------------------------------------- DATE----- - •----------------------------------------- <br /> Alterationsand/or.recommendations--------------------------------------------------------------------------------------- ------------------------------------------------------------------- <br /> ---------------­------------- <br /> -----------------------•--------..------------• ----------------. --------------------------------------------•----•---------------•---• •---------- ----------------- -------. ------------- <br /> ----•--------------------------------Y---------------•----------------------------------------------------------------------------- ------------------------------ <br /> f I <br /> ------------------ ----------.-.'F' -----------.----'-- ._- - .----.-.------.-._,-- <br /> t �3 <br /> FINAL INSPECTION-BY..-- - '----- I , 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 Traty, California <br /> ES-9-2M Revised W-2100 / <br />