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i KATION FOR SANITATION PEI, T Permit No. ---'Z--`.----_ <br /> (Complete in Duplicate) /� 0 <br /> Date Issued _{.. F/. <br /> Application is hereby made to f e San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance withCountyO-rydinance No. 549. / <br /> JOB ADDRESS AND LOC TION----------f7" 7----- ---Ale'15- <br /> Owner's Name__________________ _ <br /> �I�LQ�� �}�--------------- ----.--------------------- .... Phone---------------------- -_--------- <br /> Address--------------_-_------ ----------V_v__Vkck -<.� � <br /> Contractor's Name----------------------- -`-----—-------------------------------------------------------------• -------------- ------ Phone--------_------------------ <br /> Installation will serve: Residence ❑ Apartment House ❑ CommercialTrailer Court ❑ Motel E] Other ❑ <br /> Number of living units: ........ Number of bedrooms -------- Number of Kbaths -_.-.___ Lot size ......... :. ...�._...�._��t_.� .----___.'_._ <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E5_-k#ardpan ❑ <br /> Previous Application Made: Yes ❑ No �ew Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i <br /> (No septic tank or cesspool permitted if public sewer is available within,1*00 feet.) <br /> Septic Tank: Distance from nearest well.A�!Distance'from fo^ndatidr?,J__R�Mat rial------- .P,__.(l(tC_�.__ �d�(r�• <br /> No. of compartments.....__ ._.Size Liquid.depth...__._1 ..----------Capacity---- <br /> FYI?- <br /> Disposal <br /> apacity._..FYI __- <br /> Dis osal Field: Distance from nearest we! <0istance ffomk n atipn------- line <br /> p )!j/�l�-yu._ ft�� � �_.�..._.._.Distance to nearest lot ___ <br /> Number of lines__--__.--..-1------------�-�-} Length of each line___-_.. .---__ t Width of trench.....1-- ._. <br /> ` Type or filter material_.�;�:-_U4< .__-Depth of filter material_._. . .._. Total length____----._.4.-Q.._� .____.---- <br /> Seepage Pit: Distance to nearest.well......................Distance from foundation--------------------Distance to nearest lot line------__......... <br /> ❑ Number of pits - ------Lining material---- ------------ ----Size: Diameter. --------- . -- Depth..--- --- ...................... . <br /> .� : .. r, t <br /> Cesspool Distance 14h -noare ce,from foundati_on.... Linin material... .. ...... \\` <br /> Si?, tDiar�aeter Y:.r..._.Depth __ .. ... Liquid Capacity............. gals. c <br /> ( n a <br /> Privy: Distance from near st well Distance from nearest building :... ............. .... <br /> ❑ Distance to nearer lot line --- •-- - •--- -------- --------- -------------------- ------f--•-------- --- <br /> Remodeling and/or repairing (describe):------_------- -_..___..._.__--....__ ........................ <br /> ----------------------------------------------------------------------------------- ----------- <br /> ,r- <br /> ---- --- ---- -----•------------------. ---------------------- -----------------------------------------------------------------------------------------I----------------- -- ----------------------------------- .......... <br /> I hereby certify that I have prepared this applica+ion and that the ork wi a done•in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Lo al Healt yDis4rje <br /> ___Owner and/or Contractor <br /> (Signed)----X ,_ Y :U..------ ( / ) <br /> �krf: Qa <br /> By:---------------------------------------------------- --------- `{ ( , <br /> (Plot plan, showing size of lot, location of system in relation to we buildings, can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------ <br /> ------'------------------------------i'----------- DATE-- <br /> REVIEWEDBY----- ------- ------------ ----- ------------ ------- . DATE-------- --------------- ---------_----------' <br /> ---�------------------------------------------ ---------------- -- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- - DATE--- -- ---------------------- --- -------------------------- <br /> Alterations and/or recommendations: -------------------------------= <br /> -------------------------------------------------------------------------------- ---- -------------- ------------------ -----------------------------------------.._.------------------------------------------- <br /> ------------------------------------------- ------ ----- - ------ ---------- ----------------------------------------------------- ------------ ------------------------------------------------------------ <br /> --------------------------- ---------------------------------------------------------- -------------------------------------------------------------- -------------------------------- -------------------------------- <br /> ------- -- ------- -- -- ------------------------------------- -- -------- ------------------------------------------------------------- --- -------------------------/ <br /> / / � <br /> FINAL INSPECTION BY:---------- ------ ---------- 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 10-52 Revised W-2100 <br />