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LJ <br /> • + APPLICATION FOR SANITATION PERMIT Permit No. --- --__ <br /> (Complete in Duplicate) <br /> Date Issue <br /> A\ .>e <br /> Application Whereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This app Iicationis made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS�AND LOCATION----...-...---....... ---5_..- ------------ ...------ ----'�' <br /> Owner's Name------------ <br /> :-------- ----------- :--------------------------------- Phone------------------------------------- <br /> Address •------------------------------ re --------••:---------------------------------------- --------•-•-- -------.---------------------------------------------------------------- <br /> Contractors.Name.-�>---•---••----------•------------•-----•--------------------------------------------------.-------------------------------------- -------- Phone----------------------------------- <br /> Installation will,serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number:of living units: _-.°¢Z-- Number of bedrooms ..ZNumber of baths .. .. Lot size ------ZQ----- .._f• ..f..l ''QX� <br /> Water Supply:} Public system ❑ -Community system ❑ private ® Depth to Water Table -------- ft. <br /> Character of soil to a dep+h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®' Hardpan ❑ <br /> Previous-Application Made: Yes ❑} No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 4. <br /> Septic Tapk: Distance from near ' ....__.____-... istance­1111from foundation------------------- Material__-_____.____-_-._..-_-...-..........-.-..-...-. r_ <br /> p -YLNo cam artmen.ts__.__ __- ---Sizer-------------------------------Liquid depth--------------------------Capacity 131 <br /> Disposal Field: Distance from neares+iwek---4.0-Ar;,.Distance from foundation---,JQ---.-._....Distance to nearest lot li e..... ........ <br /> ® Number oz lines- .............. Length of each line__..-. -..`--__.-_ Width of,{trench.....�� -.-.-..._- ...-._.._.. <br /> Type of filter material. -Depth of filter material......-1?_ ------Total length---------4ZO-------------------- <br /> Seepage Pit: Distance-to nearest well--- ---------------Distance from foundation--------------------Distance to nearest lot-line----------------- <br /> ❑ Number of pits.-!------------------Lining material--.--------------------Size: Diameter-----------------------Depth--------------------------------- (1n <br /> Cesspool: Distance from nearest well----\---------Distance from foundation....................Lining material..-...__.__----------------...._.-.-. <br /> 1 N <br /> ❑ t Size: Diameter--- -------------------=---- -------Depth------------------------------ ------------- ---=---Liquid Capacity_--------------------------gals. 1 <br /> r <br /> Privy: Distance from nearest well-------------------------------------------------Distance from ------------------------------------ <br /> El <br /> Distance to nearest lot line------- -----•----------------------------- 1 ------------ --------------------------- <br /> ---------- <br /> Remodeling and/or repairing (describe): '--•--•-----•-------------------;---------------- ---:............. ----------------------------- <br /> t I <br /> I ! <br /> --------- - ------ •- ----------------------------------------------``= w = --- -----------------------------------------------I- -�.-----:;------------------------------------------------- - <br /> I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> ordinances, State7 laws, and rules-and regulations of-+lie'`San Joaquin Local Health District. <br /> (Signed ----------------------------------------------------------•------------------------------------------------(Owner and/or Contractor) <br /> By:------ •------------------------- --------------:----•---------------------------------------------------------------------------(Title)----------•----------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> f 3 F <br /> iF13 DEPART NT USE ONLY <br /> APPLICATION ACCEPTED BY-- ---------- <br /> -------- --- -- DATE------ --- --1�-- --�--�--------• - - <br /> REVIEWEDBY-------- ---------------- DATE---------------------------------- ------------------- <br /> ----------------------BUILDING PERMIT ISSUED-------•-i---- ------------------------------------------------------------i-----------------------.- DATE------------------------------------------------------------- <br /> '°- -- ... <br /> Alterations and/or recommendations:._". -----=--------------------- --- •- ------�-------•------------------------- ---------•-------------------------------------------•- -------•- <br /> { <br /> ---------------------------------------------------- - <br /> -1 <br /> ---------------------------------------------------•-.------------------------------------------------------------------------------- -- <br /> i -------------------- --------------------------------------)----------.-------------------------------------------------° ----- -- - ----------- ----------------------------- <br /> -------- --------------•--•---------------------------------------•----------------------- --------------------------------------------------------------------- - -------------------------------------------------------- <br /> --I Jr3 <br /> FINAL INSPECTION BY::-----'�--------���-x-��------Yan----- Date.-------- --- - ----------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT - <br /> 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES---9-2M iD-52 Revised W-2100 <br />