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APPLICATION FOR SANITATION PERMIT Permit No..I ! • <br /> (Complete in Duplicate) 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 withLouinly Ordinance No 549. --Z 1--(SZU ^0 <br /> 060-- ` u ��n�= -- -------•-----------•---- <br /> JOB ADDRESS ANb LOCAT ON__ !_ .P,_ .Q_�------------------------- `:.dna��1-D'�it- - <br /> ,/ ; / ----................_. Phone.................................... <br /> Owner's Name...... <br /> , . - - - . --------------- <br /> Address. <br /> -------------- -----� - •- ;;y <br /> Contractor's Name........ ........................ -------------------------------__-----------------•-•---.........-------•- Phone----- - <br /> Installation will serve: Residence Apartment House ❑ Commercial [:] Trailer Court F] Motel ❑ Other ❑ <br /> Number of living units: ____Number of;bed rooms:'b. _s umber-of baths j__... size __ 549,7'v- <br /> Lot <br /> Water Supply: Public system ❑ Community system ❑ Private [q�" Depth to Water Table j_Vft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe ' Hardpan❑ <br /> � e <br /> Previous Application Made: Yes E] No f`�._ New Construction: Yes [ No.❑ <br /> TYPE OF INSTALLATION AND.SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_.3-57_Distance from foundation.___�.�___---Material-___�"r, ---' _�*��' 1 <br /> _o. ocomPartments________ -Size_____ Li uid de th________ ______ <br /> Disposal Field Distance'from nearest well_._ T-I__Disiance <br /> from foundation._-.0.__..__Distance to nearest lot line <br /> Number of lines_-__-____ en th of each line._(,?la.'1F�_�_�_.Width of trench--,A._!$.4._________________-. <br /> •••---•- - --- g <br /> Type of filter material__,�T_�epth of filter material...I$......_.....Total length-------/L.94_0-__._______-----___ <br /> Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line...._____________ <br /> ❑ Number of pits___..---------------Lining material---------•............Size: Diameter......................Depth.-__----_------_-__-____----...... 1 <br /> Cesspool: Distance from nearest well.________________Distance from foundation....................Lining material................._.............. <br /> . 1 <br /> ❑ Size: Diamete^.... -------------------------_Depth,__...............................................Liquid Capacity_.........................gals, <br /> Privy: Distance from nearest well---- -------------_.........................distance Tr6mlegrgsf"6u�l+Bing''"_____.........._ ............... <br /> ❑ Distance o nearest lot line -•-•--•• r s-------j _ - --•-----•--•--..----- -----1 . <br /> 4o ML. <br /> Remodeling and/or reliring� <br /> describe):--------••---- - - _--- — <br /> __.__._________________________.__._.__.._______________________ � --sem______ _ _. ________.__.._._ .. _ � ._...;L- .53 <br /> � <br /> } <br /> ---------------------•--------•-----•---------------•------- -----------------=-------------------_--- ...............................................................--............---------••---------- --• ...... � <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ; ja <br /> ordinances, State laws, and rulesand regulations of the San Joaquin Local Health:District. Owner and/or Contractor <br /> y .._..- _---.-------..._-. { � ) � <br /> ' BYE------------------------------...................�..----•------•------------------------.....---------.........---------.....__(Title)----._.---•---------------------------------------------------- <br /> (Plot <br /> ---------- ----------..._.----------.._____(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY..----••.........•---••••--•-• I------------•----------•-•--••------••••-------•------------•• DATE:__.... ----•-------•----•--------------------------- <br /> REVIEWED DATE-------- -:-;4.W a--••----------- <br /> BUILDING PERMIT ISSUED--- _ ......----- •-•---•-- •--•----•--- ...............-- DATE----... ............................ <br /> Alterations and/or recommendations-_1........................................... -----•------- -------•------------------------------------------...--..........................----•-•••- <br /> -•-------••------------••...............................................................................................................---------_--­------------ ---------------------------•-•--- ----------- <br /> ..__.._.._•---------------•-•--•-=---•.................-•- ----.............)--...............................•................--•-•-•---•-, -•--------------•-•----------•---•----- •-=--_-•-- ----- ------ <br /> --•---•--••-----••---•-------•-----------4----------.......... ..........j...........................................---.............. ........... .........................-................................ <br /> t .............I...................••--•---• ._•-----•-- c <br /> FINAL INSPECTION BY----- -------- ---- --------• ------ - --- -----------•--•----------••-----••-----••-•--•--•---------------------••------------------------------------- <br /> Date-------•-_--✓--- --•r+�__,!______••-••••.-••-••------•---•--.._.._... <br /> ;. --------- - - _ - - _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-$1 Revised W-2106 <br />