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r' APPLICATION FOR !SANITATION PERMIT Permit No. •._ t_g...____._ <br /> � j (Complete in Duplicate) Date Issued ___.-�-`-4.�-�-�' <br /> Application 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 /> JOB ADDRESS AND LOCATION_.. . I r �' �/'�1.7�Q.1�_ - <br /> ------------ ------ <br /> --------------------•-------------- <br /> Owner's Name--------------- ' ----------- _a 0---------------------- ---- ------ Phone------------- <br /> Address------------------------------ <br /> Contractor's <br /> ------------Contractor's Name ---- -- - -------------------------------------------------- ----------- --- Phone.-A__.Z�P4!q7 _ <br /> Installation will serve: Residence [e""'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms __ Number of baths _1--- Lot size .......5-49-, rte_ _---------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table,�Rnt. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q-151ardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No 0� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Talk: Distance from nearest wellDistance from foundation_1_0...........Material____ --c- ,ti-_.._------ <br /> No. of compartments____----a?.._ r « " � <br /> -----------Size---�-�Q----"�--�•�o-'---'taqu:d depth-__-*�--��--'---------Capacity--•I�-P-1*�------ <br /> a ,f <br /> Disposal Field: Distance from nearest weli.._(4s-} Distance from foundation---!9"~-----Distance to nearest lot line---- _. <br /> [ Number of lines-------- ---------- - - Length of each line----/.3 ` ________.Width of trench-----. -' -!------------_---- <br /> r <br /> Type of filter material______ .-+.___Depth of filter materiaL._____l '�_----Total length-------I,. �_______________ <br /> Seepage Pit: Distance to nearest well_,47.�------Distance fr fc ndation_____' -- Distance to nearest lot line___ __afi_-�- y <br /> Number of pits.---I---------------Lining mate ria l_L'�s}-Size: Diameter....�-�-��--------Depth-----�-J--�------------- N <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______--__-______._______ ` <br /> ❑ Size: Diameter--------------------------------------Depth--------------------------------------------- _----Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----------_____-----.,-------------------------Distance from nearest building___.___--.__.___-_______-._____________- <br /> ❑ Distance to nearest lot Iine_------.`.<-------------------------------- -------------- <br /> Remodelingand/or repairing (describe);----------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- f <br /> ------------------------------------------------ --------------•--------------------------•---•-----------------------------------------------•--­------------------•----------------------------------------------- <br /> I bpretrtellify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinanVsfiatlaws, and rule and regulations of the San Joaquin Local Health District. <br /> (Signed) --------- --- ----- -------- ---------- - ----- -----r�� <br /> ----------------------------- ---- Contractor) <br /> ----------------- ---- ------------------- -- -- <br /> -� - -- - ---- <br /> By: -----(Title)--- - - . --• -'-u--------- -------- <br /> [Piot plan, showing size of lot, location of system in relatio to wells, buildi s, etc., can be pla ed on reverse side). <br /> FOR DEPARTMENT USE ONLY �1 <br /> APPLICATION ACCEPTED BY------------------ <br /> REVIEWED <br /> DATE r �� <br /> REVIEWEDBY------------------------------------------- - - ------------------------------------------- ------------- DATE------------------------------------------------... <br /> BUILDING PI PERMIT ISSUED - --------------------••------- DATE <br /> Alterations and/,or recommendations:____.___ ':------------------------------------------------------ _ <br /> !r-!__________________�____ <br /> --- <br /> �` <br /> -- <br /> FINAL INSPECTION BY:_-_-_- / Date. l-lam <br /> ---------------------------------------- .J . <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 Tracy, California <br /> ES-9-2M ; Revised W-2100 <br />