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APPLICATION FOR SANITATION PERMIT Permit No. �____Q___-, <br /> (Complete in Duplicate) <br /> Date Issued <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 No. 549. <br /> JOB ADDRESS AND LOCATION------------- �-LV.4.� ------- -V-1��// ie. p'`-~!-------------------------------�--l!--��-------------------------- <br /> Owner's Name__ 4rtr __ 51R+ 7/ev,". a ------------------- Phone.7l�_S-91 <br /> -- <br /> Address-------------"-"---•--------------------------st(o--_ _a_s_1_ R.Q/4 A ----------------------,------- I1------------------------------------------- <br /> Contractor's <br /> ---------------------------------------Contractor's Name-------------" ,c. .------------= •--{-•------•--•---.---- Phone -V_. --�� <br /> Installation will serve: 'Residence, Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1. -- Number of bedrooms __'-_ Number of.baths __/___ Lot size .---------------------- <br /> Water Supply: Public:system 19 Community system ❑ Private ❑ Depth to Water Table 347 ft. " <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeXC Hardpan ❑ <br /> Previous Application Made: Yes ❑ No jj!�_ New Construction: Yes h No ❑ ` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: m •'' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 <br /> Septic Tank: Distance from nearest well1D�f4t _ Distance from foundation____T-_-________.Material___________________________________ --------- <br /> Septic <br /> No. of com artments___ItI___._______ _4"' .,/" <br /> p � _-_--_Size-- - --�xC-?�.--1_�--Liquid depth---�.'r----- ::Capacity--�Q_�__ �1S <br /> .s <br /> Disposal Field: Distance from nearest well_K�-._Distance�rom foundation�Q_____________Distance to nearest lot line__.__..... <br /> Number of lines_____I------------ _ ._.LengtPc'f each lire- -�?_____,- - �s__...Width of trench-, -+1-7!i sr_ <br /> - /S..---.....Total length _ __.G�R.� <br /> Type of filter material-"`_f Depth.of'filter material_.__._ <br /> Seepage Pit: Distance to neareetwell`:l±f�r__-__Distance afro foundations.."_.....___.Dmstance to nearest lot line_____v ____._ <br /> Number of pits---�___ g r <br /> (� -- ---Linin material-- -- __-- _-Size: Diameter___�,3��--_--.Depth.---�-�-�--------- ----- <br /> Cesspool: Distance from nearest well_________________Distance from foundation__.__ _--------Lining materia!-__�'.-_______.__-.______________._. r <br /> ❑ Size: Diameter a = Depth Liquid Capacity---- -------------•--------- gals. N <br /> Privy: Distance from nearest,.well......--------- ..______.____-_--.-_____.._'_Distance from nearesf building-------------------------._._-_--------------- <br /> I <br /> ElDistance to nearest.'lot -line------------------------------ -*----------•-=---------•--- ----------------------------;-------------------- ------ ------ <br /> + <br /> Remodel g an o repairing (describe):____ l�lr.__�.___ _ Q:-_-e 14r ____l ---------------- <br /> -•---------- ��+ -----`------- ----------------•--------------------------•--------------•-----------------.----------------------• <br /> ------------- -•----- ----------- --------------------------- --- -------•-------•------- -------------------------- I <br /> I hereb certify that l have prepare this-applicaf ion.and.that-the work L will-be done in accordance-with San'Joaquin County <br /> ordiniancIT 43 <br /> laws, and rule nd relulations of the San Joaquin local Health District. <br /> {SigneCd} • ---- -- ------•---..__...- ( Contractor} . <br /> ---------------- <br /> By:........................... - ----- --------------------------(Title} � itxc� Q �r------------ <br /> (Plot plan, showing size of lot, location of syste ' relation to wells, ildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------- R----- -- ---•-------•-----------------------•--- DATE------- 3 ------ <br /> ---------------- <br /> REVIEWED BY---------------------------- --------------------------------------------------------------------;-------- DATE---•----------------------- <br /> -------- --------------------- <br /> BUILDINGPERMIT ISSUED------••--•--•--------------------- ----------------------------------------------------------------- DATE--------------------------------------r--------•-•--••------ <br /> - Alterations and/or recommendations------------------------------------------------ -----•"--------------------------------------------......................------------------------------------ <br /> ----------- <br /> ----••---------------••------------________________________________________--------------------------------­__________________________________________________________r___---.__-_-_.___._________-_______--_-.__-----________--________________--_-_-_---____ <br /> _____________________________________________________________________________________________________________________----------------------------------------------_----------------------------------.-------------------------- <br /> -------------------------________________________________________________________________________________-_-.---__.--_________.__________.`______:_ -------------------------------------.-----.____.______._-_____..___- <br /> FINAL INSPECTION BY:--------------- -%-= - --------- ---------- Date----------------------------------------------- <br /> -----------------------. <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 />