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r K r 11-e uac: <br /> - '- - � � /T <br /> �{ --- --------- ------ --- <br /> ,�:ICATION FOR SANITATION PER Permit No. ... .. -_ <br /> ------ --------- - ------ - (Complete in Duplicate) ��ff // <br /> Date Issued .---j_-._�:.-@_� <br /> ---- ----„-------------.-_-. <br /> ------- ....- This Permit Expires 1 Year From Date Issued <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 NN549. <br /> JOB ADDRESSTION- -___ ...- r ----•--- <br /> - <br /> J} �- ,ten^/ '/ �/ ---------- <br /> Owner's Name-- ---- ---...x��Crt /a -----�' - - - Phone-Y.6 r1 - <br /> Address ----------- ------ - -- <br /> Contractor's Nam - - ------ -- -- � � .. --a Phone Y�OtZ ci 1- <br /> �D% <br /> Installation will some: Residence parfinent House ❑ /,mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -.I.:.- Nu er of bedrooms --2--.-Number of baths j.... Lot size -J_61�1.V-_..-- ---a��------------------ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -(p ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--loardpan ❑ <br /> Previous Application Made: (if yes,date-----------.........I No ❑ New Construction: Yes ❑ No �A/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic t or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest well-----------------Distance from foundation....................Material............................................._. <br /> is .. <br /> No. of compartments----------------_-----Size................................Liquid depth.----------------------Capacity--------------- ---- <br /> posa ield- Distance from nearest weII.F+\o.s1E---Distance from foundation-.f.Q.---.--...Distance to nearest lot line...- ...... r <br /> d Number of line --- <br /> ...... ....... Length of each line---------- ,� �� ' 6 <br /> J .�...Ct--..-.Width oftreneh--,2e-S�,--------�`------- <br /> R� Type of filter material r,. k..__Depth of filter material y-.-Total length.................sZ_P_._ .......... <br /> See age Pit: Distance to nearest wall. Cft.G-__--_-DistanceQQfrom foundation----J �.--.Distance to nearest lot line.__.-- .._.. <br /> Number of pits._F......._.--.--..Lining material-lW.c�--------Size: Diameter-Z. J.F......_Depth_Z__ __________________ rn <br /> Cesspool: Distance from nearest well----------__...Distance from foundation....--_-..._______.Lining material-.------------------- <br /> --- <br /> ------.--. <br /> ❑ Size: Diameter............----------_-----------Depth--------------- ------------Liquid Capacity_-----------------------gals. <br /> Privy: Distance from nearest well............................ ....................Distance from nearest building----------..------------.-.--.......-...-. N <br /> ❑ Distance to nearest lot line--------------------------------------------------------------------'-----------------------------------------------_ ------------ <br /> Remodeling <br /> Remodeling and/or repairing (describe): <br /> (describe):------` --------------- <br /> = .................................. - <br /> - .....-------- <br /> --------------­-­---- <br /> _.._. <br /> --� ---' <br /> --------------------'-------------- ------ --------------------------------------- - <br /> ---- - ----' ---------------------------------------------------------------------------_---------------- - --------------_------- ----- ----------------------------------- 1 <br /> I hereby certify that 1 have prepared this application and that 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 /> ----. --- -- _ �ym� oContractor) <br /> (Signed) <br /> ^ 2Ve ` <br /> ------- --- <br /> By:---------------"'---------'-........................---------------------- <br /> (Plot plan, showing sire of lot, location of system in relation t ells, building et ., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- C---------------------------------------------------------------- DATE-..- �F- "------------------------- <br /> REVIEWEDBY--------------------------------------...........................-....---------- ................ -----•--------'--'------ DATE------- ------------_-_---•------------------- <br /> .. BUILDING PERMIT ISSUED............................................................-................................. ... DATE----- .................-..."'......................- <br /> Al+erations and/or recom en tions:.............................................. <br /> - a -r - " '--------------------------------------------------------------•------------- - - <br /> -' --------------.... .. <br /> ----------------------------------- ---------------------------- --------------------------- ----------------------------------'---- <br /> -Y 1001 <br /> �_ <br /> FINAL INSPECTION BY:------ ----.... Date...-----' `-- ------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Xardton Avtr. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton, California Lodi,California Manteca,California Tracy, California <br /> ES 9 REVi5E0 0-59 3M 3-'63 F.P.CO. <br />