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VV <br /> APPLICATION FOR SANITATION PERMIT Permit No, <br /> (Complete in Duplicate) Date Issue <br /> Application is hereby ffiacle 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 /> -10-N <br /> JOB ADDRESS AND LOCATIO <br /> t, 4-------------------------- <br /> Owners Name.-------- (D M_ _ ...Lay------------------ 5F <br /> Phdm_�O------ <br /> Address"-------------------------:-:p <br /> - - -------- <br /> Contractor's Name. -------------Z ------------------------------------------------------------------------------- Phong_ -.'_A, <br /> Installation will serve: Residence De Apartment House Ej Commercial E] Trailer Court El Motel EJ Other 0 <br /> Number of living units: __'Number of bedrooms ---7-.'Number of baths __47�'Lof size <br /> ---------- -_-l- ,S`---------------- <br /> Water <br /> . .............Wafer Supply: Public.system W Community system El Private F <br /> Depth to Wafer Table 107 ft. <br /> Character of soil to a depth of'3 feet: Sand E] Gravel E] Sandy Loam [I Clay Loam El Clay ❑ Adobe Hardpan E] <br /> Previous Application Made: Yes E]I No E] New Construction: Yes E] No El <br /> TYPIINSTALLATION AND SPECIFICATIONS: <br /> (klo septic tank or cesspool P16irmiffed if public sewer is available within 200 feet.) <br /> e c T Distance from nearest well-----------------Distance from foundation_-.___________.___Materiai--------- <br /> No. of comparf ments---------------------------size--------------------------------Liquid,depth--------------------------Capacity----------------------- <br /> spos�Fiedi Distance from nearest well_90kA--_/..Distance from foundation__ �_.Disfance to nearest lot line-----40-7 <br /> Number oi,Iines--------I------- Length of each I�ne------11E ----------Width of french.---. 47!... ................ <br /> ;4()- v­--coj----- 01 <br /> Type of filter material-:_t-71---- ---- ---Depth of filter material-----/,S-' ------------------- <br /> ----------Total length------c- -,---- ----- <br /> pqg� Pit, Disfanc"6-f7nearesf welltA ----Distance fr9fn` fo'undafion---:)- -------Distance to nearest lot I'ne___/q_ <br /> -----------Lining material .__.Size: Diameter--- --- <br /> Nu,mber of pifs_�---/_ - .3, 3- Depfh_A_-- -------------------- <br /> Cesspool; Distance from nearest well-----------------Distance from foundation -------------------Lining material----------------------------------- <br /> Size. Diameter_ <br /> ---------Depth------------------1�----------------------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building_____.___-_______--___________----__-_._. <br /> ❑ <br /> uilding----------------------------------------- <br /> 0 Distance-to nearest lot line--- ---------------_-------------- ---------- <br /> Remodeling and/or repairing {describe):----------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------------------•-----------------••--------------------•--•----------------------------------------------------------------------------------------- <br /> ------------------------------ -------------------------------------------------------------------------------------------------------------------•-------------•--=----------------------------------------- <br /> ------------------------------------------ <br /> ---------------------------------------------------------------:----------------------------------------------------------------------------------------------------------------------- --------------------------------------- <br /> I'hereb.y_ce-rFif-y-fhajf I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinaricest'Stafelaw!,,Ad rules-and r gulations of the San Joaquin Local Health District. <br /> f <br /> (Signed ---------------------------------- ---- - ------ --------- ---------------------------------- ----- Contractor) <br /> ---- ------- <br /> By:--------------------------------------------- 1—a------------------ --------------- <br /> (Plot plan, showing size' of lot, location of system in jhafion to wells, burs, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -------- DATE------ <br /> ---------- DATE----------------------- <br /> REVIEWED BY-------------------------------------4 <br /> ---------- ------------------------------------- <br /> BUILDING PERMIT ISSUED................r----------------------- ----- ----------------------------••----------------------- DATE-------------------------- <br /> Alterations and/or recommendations! <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 6 <br /> ----------------------------------------------------------------------------- ------ ----------------------------------------------------------------------------I----------------------------------------------------------- <br /> ---------------------------------I-----------------------------I---- ---- -----------------------------------------­­-------------------------------------_----------- ----------••-------------------••_----------------- <br /> ---------------------------------------------- ----------------------------------------------------------------------------------__ ------------- --------------•----------------------------------I-----------_­------------------------------------------------------------------------------------------------------------------------------------------------ <br /> 4 <br /> FINAL" INSPECTION BY:..----------- - �-----gvmw// -------- 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 Tracy, California <br /> ES-9-2M ; . Revised W-2100 <br />