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c . . <br /> .� APPLICATION FOR SANITATION PERMIT Permit No��..__.. ..... <br /> �\ (Complete in Duplicate) y <br /> Date IssuedLr 3_ <br /> Applic&ion 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 No. 549. <br /> JOB ADDRESS AND LOCATION cvG e- --- --- -- ------- <br /> 04 <br /> Owner's Name ' -'!L--------------- ------- - ---------------- - ------------------------------------ Phorie_ <br /> Address__---_---------------�- f <br /> -- ------ --------------- -------------- ------------------------------------------ <br /> - 5 <br /> _______ _f}____ / q <br /> Contractors Name ".^t'�C,,, `'�'J _ ©7 <br /> Installation will serve: Residence [R�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: _,-__ Number of bedrooms _�-. Number of baths ---J__ Lot size __ 4--� ��0 E]-- --- -------------------------------------- <br /> Water Supply: Public system 2--l'Comrnunity system ❑ Private ❑ Depth to Water Table _kO ft. <br /> Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> r Previous Application Made: Yes No <br /> pp ❑ 2----New Construction; Yes ER-'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------ <br /> .`------Distance from foundation_____(F--- ___ Material___�__`----- ------------------------ <br /> -- <br /> [VY No, of compartments---------�_____......Siz�1{i_, 4y+� _ _Liquid depth___�r��!'-.________Capacity___ ___dd_- <br /> s Disposal Field: Distance from nearest well_________________Distance from foundation,-------------------Distance to nearest lot line---------------­�j <br /> 1 t[ 3� umber of lines-------------------------------------Length of each line------------------------------Width of,trench------------------------3 ` <br /> �y Type of filter material---------------_---------Depth of filter material-----------------------Total length------------------------------------------ <br /> Is <br /> �ee <br /> -_ __- <br /> `Seee Pit: Distance to nearest well -______-----------Distance from foun ation__..... -----------Dis ancl,t o nearest lot line___— <br /> Number of pits-f._-1_____________Lining material___ Size: Diameter----------s .------_Depth_____, 5--------__-._--- <br /> Cesspool: Distance from nearest well________________Distance from foundation-------------------"Lining material__. <br /> ❑ Size: Diameter______-____-_ _______-______.___________________ ►"�J <br />,. .................................;Depth------------------------------------ ---------------Liquid Capacity------------------ -- ------gals. ' <br /> • <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_- ------------------ <br /> ❑ Distance to nearest lot line________________-___--_____-____________----------------- <br /> ------•---- -----------------------------•------------------•------------------- <br /> Remodelin and/or re airin describe :_ - _ . _` ►-f- E''___ _G2____ _ - C C e� d/!� CS <br /> g / p 9 ,y - - +'---• ---- k y <br /> J^ �- c2a------ 4_.:.� s +�--- -----f ea x� <br /> ---------------------- <br /> 1 - - 1 <br /> ______________________________________________________________7______________________...___._.-_-_____________________----_-_____________________--.--_____________________-____ <br /> ________________-I-------------------------------------- ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------- <br /> I <br /> __-__-_______-____ -__ ______________._____________--____--_______________----_____________________-__--___________-._-_________________-_________________________--_______________________--__-_________- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Statelaw and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---------- •------------ •----- ------ -------------------------- ------------------ �Owner /or Contractor) <br /> BY; s --'-------------------------------------------------------------------------(Title)-- ------------------------ <br /> -- <br /> (Plot pian, showing size of lot-location of"system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 4 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- .17hf - ---- DATE f ------------------------- <br /> REVIEWEDBY - --------------------------- -------- ------•-------------------- DATE--- <br /> ---•------------------------ <br /> BUILDING PERMIT ISSUED----------------- ----------------------------------------------------------------------------------- DATE <br /> Alterations and/or recommendations:---------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------- <br /> -------------------------------------------------­---------------------------------------------------------­----------------------------I------------­------------------------------•------ <br /> 5 <br /> _____________________________________________________.-_ <br /> L. <br /> 1 fNAL INSPECTION ----_----- - ------ Date_----_ --- J. <br /> SAN JOAQ)UIN LOCAL HEALTH DISTRICT <br /> 30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreof <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M : Revised W-1100 <br />