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APPLICATION FOR SANITATION PERMIT ' ✓ Permit No. <br /> - —s C{_- P% 0 0 /l• M. (Complete in Duplicate) Date Issued <br /> Application is herebymaE9e to the San Joaquin Local Health District for a permit to construct and install the work erein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION 49- f <br /> _ r< f--------1DT 111- ------ A � 4-------------------- <br /> Owner's Name -��Q --------------------- ------------------ Phone- ;------ --- -- - 57 <br /> ? <br /> Address_ <br /> pp �/ <br /> l� s ----------- Phone.-F-Ze e-7Contractor's Name <br /> Installation <br /> ; <br /> will serve: Residence ❑ Apartment }-louse ❑ Commercial ❑ Trailer Court W" Motel ❑ Other ❑ I <br /> Number of living units: ___ Number of bedrooms _ Number of.baths ___--_ Lot size J- ......._---_------------- <br /> Water <br /> _ __________Water Supply: Public system Community system .Q Private ❑ Depth to Water Table-51-Q_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] AdobePq Hardpan El <br /> Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No [X }' <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❑ No. of compartments--------------------------Size-------------------------------Liquid depth----------------------- Capacity----------------------- <br /> Disposal Fiefd: Distance from nearest weIl_1V49 !F.__Distance from foundation_1Udff(2: __Distance to nearest lot line__��__-��__—_1.... <br /> Number of lines--- -- <br /> Length of each line__. „a�"''_ Width of trench__ __-___ I <br /> of filter material `t�i'Od p �� g ------------------- <br /> Type <br /> ------------- <br /> - --_---- --_-'�--De th of filter material----��-----____--Total length <br /> Pit: Distance to nearest well-)YPnCd-___-Distance from foundation_./-Ye?A/e--_..D'sfa!ce to nearest lot line—,g4'-�___01 <br /> Number of pits__--_Lining material--o-Koe,Kw_-Size: Diameter_--g-----------_.Depth_.90_______________________ <br /> Cesspool: Distance from nearest well_________________Distance from foundation-------------------Lining material__-__-.__________________-___________- 0 <br /> ❑ Size: Diameter--------------------------------------Depth---------------------•------------------------------Liquid Capacity--------------------------_gals. � s <br /> Privy: distance from nearest well ----------------------------------- _____-----Distance from nearest building--------------------­--------------------- <br /> ❑ Distance to nearest lot line--------------------------------------------------------------••-•------------------- <br /> r <br /> Remodeling and/or repairing (describe):------- ............... -------•-•-- ------------- <br /> ------------------------------------------I......­­­------- <br /> ------:---------------------------------------------------------•-•------- ---------------------------------------------------------- s----------------- <br /> ---------------------------------------------------------------------------- J <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------.------------------------- <br /> I hereby certify that I have prepared this application and fhat 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 /> Owner a or Contractor <br /> (Signed) [ / 1 I <br /> r BY: ���� - Pd� <br /> �`f -- -------L�--------------------------(Title01 <br /> r { <br /> i (Plot plan, showing size of lot, location of system in rela ion to wells, buildings, etc., can be plac r�on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> r <br /> t APPLICATION ACCEPTED BY- -------------- ------•-----=---- ------------- =-------- DATE-- <br /> 3 <br /> REVIEWED BY ------------------- ' ------------------------ <br /> ---------------------- ------------- DATE---- p---------------------------------------------- <br /> BUILDINGPERMIT ISSU> D------------------------------------------------------------------------------------------------------ DATE---------IR&--------------------------------------------- <br /> Alteratiions and/or recommendations-----------------------------------=------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------- ----------------------------------------------------------------------.--_--------------------------- ---------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------- ------------------------ -----------I--- ---------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY----- ----------1e41______ <br /> -- ---------------------------- Date -- ----`moi' <br /> l <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT - <br /> 130 South American Street 300 West Oak S+reef 132 Sycamore S+reef 814 North "C" Street <br /> Sfockfon, California Lodi; California Manfeca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />