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�p <br /> ! r CATION FOR SANITATION PERMIT Permit No.�___Q.__3-_�- <br /> ;. <br /> / _(Complete in Duplicate) <br /> Date Issues! __��_�_/�� <br /> r- <br /> 2-.9'7—0 2— � <br /> Application is hereby m e to the San Joaquin Loca Health District for a permit to cons4cYAnd install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. fit' <br /> JOB ADDRESS A,IqD L O Flo <br /> © -------------=-'-------------------- --= ---- -- --------------•----- --- <br /> ---------------------- <br /> Owner's Name C� � f� <br /> tl -------------------------- � �� ------- Phone <br /> _______ ___________ ____ __ _____A-.-_-_--_____________..______.-.-_--_ _ _._ ___V___ <br /> Address.-....------ �* <br /> KContracfor's Name------------------------ r--- - ---------------------------------------- ---------------------------------------------------_ Phone------------------•-----•---------- <br /> Installation will serve: , Residence [Apartment House ❑ Commercial ❑ Trailer Courtf❑ otq ❑ Othpr El <br /> Number of living units: __/___ 'umber of bedrooms __'I____ Number of baths __.(___ Lot size _______!�___ _-/- V___._____-___.__- <br /> Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table ________ ft. <br /> ++ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ -'Clay Loam ❑ Clay ❑ Adore Z/Hardpan ❑ <br /> Previous Application Made:-Yes� -� —No <br /> pp ❑ M p'"New-Gonstruc#ion:Yes-2/—No=❑� ��•- . .� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> f (No septic tank or cesspool permitted 'if public sewer is available within 200 feet. <br /> Septic ank: Distance from nearest well___.__�` Distan a fro foundajion___ _______-__.Ma 'al _�`74 <br /> ��jj� <br /> e No. of compartments-- -_-- -----N ._.Size_2--� -- __Liquid depth---'- =--------------Capacity---- --Q- 7 <br /> Dispos field: ' Distance from nearest well p-� �_ _ _ (Mance from foun*Tfiion-,-/O�-V�­ Ilfance__ _ ___ to nearest lot linef 6, <br /> ` ^ Number of lines----____-- •.-- �� Width of trench--____-- --eti ______ ___]-_.-_-___ -__ Length of each linE___T. e of filter materi . _ �De th of filter ma ______ _ W. r <br /> YP - p �j Total length <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 /> Cesspool: Distance from nearest well_________________Distance from foundation___________.__.___.Lining material__.________-_____._..____------------ <br /> ❑ Size: Diameter------------------ -------- ----------Depth------------------------------------------- --------Liquid Capacity-------------------_--------gals. . <br /> Privy: Distance from nearest well---------------- --------------------------------Distance from nearest building___-----________________-----------------. a <br /> ❑ Distance to nearest lot line------------------------ <br /> I � ------ <br /> 1 Re odeling and/or repairing (describe):+" " ----- -------------- ---- ,A-0--- ------ > <br /> 1 . . , _ --.--' _---------------•-------------- `� <br /> •--------------------- -•----- <br /> f <br /> --------------------------------------:-- , <br /> ----------------------------------------- <br /> ----------------------------- -------------- ------------------------------------------------------------------ ----------------------------------------- -•- <br /> --------------------- ----------------------------- ---------- ib <br /> I. I hereby certify fhat"I have prepared this application and that +he work will be done in accordance with San Joaquin County O <br /> ordinances, State laws, nd rules and regulations of the San Joaquin Local Health District. I <br /> (Signed)..) (Owner and/or Contractor) <br /> t <br /> By: `.... - (Title) ------------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY + <br /> APPLICATION ACCEPTED 'BY---- ------------------------------------=-•--------------•------_------- DATE- <br /> REVIEWED <br /> ATE REVIEWED BY------------------------------- ------------------------------------------------------------------------------------ DATE <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------- - ---------- DATE...... '"� l <br /> -----•--------- <br /> Alterations and/or recommendations:---------)- -------------------------------- -•------- 1 <br /> ----- ----------- <br /> i - 1' !lL-------- 4_C_�1!�--------------• -- -------------------- •---------------- <br /> ------------------------------------------------------------ <br /> 1 � 1.-------- 5rr1 /.�z: -------• ----•-•-------••------- <br /> x <br /> -`-------....._---------`-1;� -f---------------------------------•------'....______-------------------------. <br /> ----------------------•----------------'----..___------.-.._�___ -------�----------------- 1e� •-.---.----&[-Y-�-�i�- -------- <br /> y . ----- <br /> I?!� mv�C <br /> FINAL INSPECTION BY:......... ��- '---------------- - Date _ <br /> � 1 <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 /> S <br /> ES-9-2M io-52 Revised W-2100 <br />