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D <br /> I�A <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> tae (Complete In Duplicate) Date Issued <br /> pli <br /> A or, tion is hereby made to the San Joaquin Local Health District for a permit to construct and ins+all the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> Qom/ p <br /> JOB ADDRESS ANQ LOCATION <br /> -------WA 1-"L-6/0.... Q P_-----— <br /> Owner's Najne_,_'K,-Z�.....7-dLE-RA-r__-_----------- Pho��./_lIC�T.... <br /> ----------- :,_72,7e•.......... <br /> Address..----.._... a ......... <br /> _�............ <br /> Contractor's Name_ 39 _XR.Rj,1jV...... ....... ....................... Phone._ <br /> 7' <br /> Installation wig serve: Residence I—] Apartment House C1 Commercial A Trailer Court 0 Motel 0 Other 0 <br /> Number of living units: ------Number of bedrooms.. Number of baths Lot size -------------------- <br /> Water <br /> ------------ <br /> Water Supply: Public system ', Community system 0 Private 0 Depth to Water Table !�. . <br /> Character of soil to a depth &13 feet: Sand E] Gravel 0 Sandy Loam[_1 Clay Loam [] Clay 0 Adobeig Hardpan 0 <br /> Previous Application Made. Yes [I No.IX New-Construction: Yes [-] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: S4 <br /> (No septic tank or cesspool permitted if public sewer is available within 260 feet.) <br /> septic Distance from nearest well-----------------Distance from foundation..................Material...................................... <br /> No. of compartments..........................Size-_ -__------.._..._-.__-Liquid depth.......................Capacity...................... <br /> �, Fii Distance from nearest welf.joyeva-_-Disfance from founclafion__AO.........Distance to nearest lot lina_=_ <br /> Number of lines....A!9 6(4�.* Length of each line.... ----------------Width of trench.,44L, ........... <br /> Depth of filter material.... ........Total length---------;AV..................... <br /> ter a] <br /> Type of filter me <br /> Seepage Pit: Distance to nearest well -/YdYC-----Distance from foundation../O---------Dis%nce to nearest lot <br /> ANumber of pits-.61V .......Lining material.'s...- Diameter.4. ............. ........... <br /> Cesspool: Distance from nearest well--.............Distance from foundation.-_.............-Lining materiel---..-_...._.....-_-.--.__..____-. <br /> F❑ Size: Diameter-- ------.......... ...........Depth--------- <br /> --------............ .......Liquid <br /> Privy: Distance from nearest well............................:_............_---__Distance from nearest building___........................ <br /> [I Distance to nearest lot line-----.....--- ---I--------I-------—------------- ----—--------------------- <br /> Remodeling and/or repairing (describe):-------� ---------- ..... . <br /> . ............................­­­.................................................................................................................... .I <br /> .. .-^----------•------------------ <br /> ............................................................. ....... <br /> ..................................—---------....... ...............-------------...•----------•------------------------------..._..-_-......_- <br /> 1 <br /> ..................................................I hereby certify that I have or Is application and that the work Will 6e;done in accordance with San Joaquin County <br /> rules <br /> ,:or <br /> ordinances, S aws, and i in u,a *ons of the San Joaquin ocal District. <br /> igned�__- 08 <br /> (Signed).......`_ ----e.... -------- _- ......(OnerAfnd/or Contractor) <br /> . . ...........----- -- <br /> (Plot plan, showing she of [of, location of system i r�eilafion to wells, buildings, etc., can be pla4d on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_l ----------_---------......................................................... DATE_S:............................................. <br /> REVIEWEDBY----- ................... .. _. ................................­.................................. DATE. <br /> BUILDING PERMIT ISSUED..------- <br /> .................4- --- —------—-—-----­-------------- DATE. —-------.. -•----....-----------•---........3e..-•-- ---- <br /> Alterations anclh� recommendations:--............. ..........................---------------_---- <br /> . ------ <br /> ----—------------------------------------------ ­-­--- -----...............I.............................................................................................................. <br /> ------------------ -----------.....................I--------------------------------- ....................___..........................._ _.. .... <br /> --•---------.._.._.._.........------------......................................... ................. ....-----•........------ ­----------------_............... .:!E. <br /> ------•....--- ..............................­---•---------..............------------------------------- ....................---------------...........___­------- <br /> FINAL INSPECTION BY:_146��- ------ ------- <br /> ..........I-------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 S..fh Arn.rl... Sh.ef i 300 W.0 Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> ES-9-2M 8.51 Revised W-2100 <br />