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APOSdATION FOR SANITATION PERMITS Permit No.�-7-k-:1-- <br /> (Complete in Duplicate) <br /> Date Issued,//!...t/-2w 'y <br /> Applica+ion is hereby made to the Son 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 /> - IF— <br /> JOB ADDRESS AND L ATI .. .. ...........C*&0_1 .... ... -------- <br /> ---------_--............ <br /> Owner's Na .. ---- ---- .111�.................. ... ----------------------------- ­ Phone,��... <br /> Address --- ---- <br /> 00- -- --------- <br /> Confracbr's <br /> -------- --- ---- ------------------_--- ------------- Phone-, <br /> Installation serve: Residence Apartment I� ouse [W] Commercial ❑ ijrailer Court El Motel ❑ Other <br /> Number of living units: ---/--- NUmber of bedrooms Number of baths _/_ --. Lot size - _,etnne-?---------------- ---- <br /> Water Supply: ' Public system)2r Community system [] Private L] Depth to Water Tablgo/e ft. <br /> Characterof soil to a depth of I feet': Sand El Grove] 0 Sagely Loam 0 Clay Loam El Clay El Ado Hardpan El <br /> Previous Application Made: Yes 0 N� New Construction; Yes <br /> VO4 No L] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic,tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest well------_----- --Distance from foundation----------------...Material-------------- --------------- -------- <br /> '0. 1 . <br /> No. of compartments------------------------Size-------'--------------......Liquid depth----------------__.... Capacity------ <br /> Dis�os d: Distance from nearest w`ell-----------------Distance from foundation--- ------ --------Distance to nearest lot line._.__....----- <br /> 4-1 f <br /> Number ;f lines__...-----------------------Length of each line._._-`-----------------------------Width of trench..----------------------------- <br /> Type <br /> rench---------------------------------- <br /> Type of filter material_._..- ------------Depth of filter material.......................Total length.-__-..--.._--..--..-_--_--..-_-- <br /> Seepage-Pit: Distance to-nearest ----- -Distance. !pm fou,,AfionA4Z9-A----Distgnce to nearest lot line-.-gr._ <br /> Number of pits.../---------------Lining material- zr_ 'lSize: Diameter..---------- -----Depth...----7 ��.............. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__.-__.._--- Lining material.__...__.._.--_------------------- ------- <br /> F1 Size: Diameter....................... ...............Depfh___-------------------------------------------Liquid Capacity----------------------------gals, <br /> Privy: Distance from nearest well---------------------------- .... .............Distance from nearest building--_._.._.._.----------.____ _- <br /> ❑ <br /> uilding----------------------------- <br /> F-1 Distance to nearest,lot line._------------------------ ---------- --------_1---------- --------------��­­ ------------------ <br /> 'in <br /> Remod lin re a* (describe): <br /> a) ---------- - -------- -- ------ <br /> --------------------------------------------_---------........ --------- .. .......... -- <br /> . <br /> ------------------- -_--------------­----------------------------------------- <br /> . .... --------------- ------------­---- .................---------------------------------------------------------------------------- ----------------------------------------......... <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. St laws, and rujilis and reaulattons of the San Joaquin Local Health District. <br /> (Signed).. .. ............. .... ..... - - ­ -- - � <br /> -- ---- <br /> Owner(and WContractor) <br /> ..... ....... <br /> By:........... - - -- -- - - - (Title ------ <br /> (Plot plan, showing size of lot, tot6ion of system in relation to wells, buildings, etc., can be P!�o n rever ;R,). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----_----- --- ---- --------------------------------------------------­---- DATE-----------=-------- ------------- ------- <br /> REVIEWEDBY.------------------------------------- ---- ---......... -------------------------I------------...... DATE---------------.--------. . . ............... <br /> BUILDING PERMIT ISSUED--------------------- ---------- - --------- -------------_.-..------------------------------- DATE----- .............. -- ---_-------------------- <br /> Alterations and recomm;ndations,;------------------- <br /> .......................... ------------------_ -- ---------------------- <br /> -------------- ......................:­ <br /> ................................ ----------:..................................... .........____...... ............ ----- ...................... <br /> .......................--------­­------------------------------------.......................................................7...................................................................................... <br /> .........................­.............................. .... .. .. ... ......... ...........................................------------------------------------- - <br /> ------------------------ <br /> --------------------------------------------------------- .... .......................... .............. ---------------------- -----------------------------------I----------- ---------------- ............ <br /> TION BY.. <br /> FINAL INSPEC ---------------------- ................................. ....... Date......_ .._..'.._........ ....._.._`---- -- <br /> SAN <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 R.yis.d W-2100 <br />