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1APPLICATION FOR SANITATION PERMIT \\\�Permit No. <br /> WA ­,_ <br /> (Com' plefe in Duplicate) <br /> Date Issued <br /> gA L <br /> pltca4-ion is hereby made,to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB.ADDRESS AND CATION-- Ct -----------05-1:91 ........1:::� ------------------------------------------------ <br /> Owner's Name---- ------------- --------------------- Phone----------------------------------- <br /> Addt"ess ---------------------------------------------------------------------- . ......... - --------------- <br /> ----------_--------- --- . . ..... ---- ---- -- <br /> Contractor's Name------f----- ------Qf—A ----- --- --------- -------------------------------------- ------------..-.. Phone <br /> Installation will serve: Residence Apartment House Ej Cornmerciiii 0 Trailer Court E] Motel ❑ Other E] <br /> 11 P_ . , - er-�D <br /> Number of living units: Nu'mber of bedrooms —Umber of baths _./--- Lot size ------ 9- <br /> --------------------------- <br /> Water Supply: Public system 04-Community system El Private E] Depth'to Water Table 6-0- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam [-] Clay,Loam [] Clay F] Adobe 0,. Hardpan E] <br /> Previous Application Made-.: Yes [] No O—New Construction: Yes 2g.—No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T k:. nce from nearest well------------------Distance from foundation--------------------Material------------------------------------ ------------ <br /> �Nof 'compartments-- ---------------Size_..---------------------------Liquid depth----------- ----.-Capacity------------- --------- <br /> Disposal <br /> apacity----------------------- <br /> Disposal Fieldr- Distanc6 from nearest weli ----------------Distance from foundation------------------...D.istance to nearest lot line----------------- <br /> El ber" of lines-----------------------------------Length of each line-----------------------------.Width of trench-----------------------------_- <br /> ` <br /> rench ---- ----------------------------- <br /> `T pe of filter material-----. -.-----Depth of-fil .. .........Total- length---------------------------------------- <br /> elp. .1i -, ( :Pq f <br /> Seepage Pit: Distance to nearest well-,-./v.... --------Dis noce fTf f ow n do a4j i o nj-- ------ --------Distan t t lot line-- -------- <br /> neares <br /> Number mber" of pits------/-------------Lining mat rial.-:0 ---------- <br /> 52— ia _4� ....�81(Diamef -------- ------Depth------ <br /> sta <br /> Cesspool: . Distance from nearest well-----------------Distan r, oun a ion---------------------Lining material----.--------------.--------_-----_-.. \� <br /> ❑ Size: <br /> aterial------------------------------------- <br /> Size: Diameter------------------------------------ --------- --------Depth--------------------- -------------- --------------Liquid Capacity--------------------------_gals. <br /> Privy: 4 Distance from nearest'well--------------------------------- -Distance from nearest building------------ ----------------------------- <br /> ❑ Disfancb to nearest lot line----------—---------------------------------------------------------- ---------------- ----------------------------------------------------- <br /> Remodelingand/or repairing (describe):------ ------------------------------- ------------------------------------------------------------------------------------------------------------------ <br /> ------------------!------ --------- -------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------- ----------------------------------------------------------------------------------------------------------------------I-------------------------------------------- <br /> -----------------�­------------- ------------------------------- --------------------------------------------------------------------------------------- ---------- --------­. <br /> I hereby cerfify�t a' I jhave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat ws, "d, rules ao regulations of the San Joaquin Local Health District. <br /> (Signe 41_' -- -� ------7e_1Z --------------------------------------------------------------------- ---- Wner and/or Contractor) <br /> ------------------------------ --------- ----------- ------------ <br /> ti By:--- ---------- <br /> 4. lo <br /> "'(Plot plan, seing'size of=o cation of system in relation to wells, buildings, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY......6------------------ ........ ------------ ---------------------------------------- DATE-------- 7_�_ -------------------- ----------------- <br /> REVIEWED BY------- !j: --------- ---------------------------------------------------------- DATE---..-. -N------- --------------------------------- <br /> ------------------------- - ---------- <br /> BUILDING PERMIT ISSUED---------------- DATE. <br /> V 4-1 <br /> ---- -------- - -- ---- --------------------------------------------------------- ---- --- ----------------------- <br /> Alterafions and/or recommendations:_ .........M---------------------------------------------------------------------- ----------------------------- <br /> 4 <br /> T�j <br /> --------------------__ --- .:-------- ------- -------- <br /> 0; ----- -------- ---------------6)------------------------------------------ \-j ..........1__------ <br /> -------------------------------------------------------------------- <br /> ------------------------ - :71-------- --- - -----1---------S;L%�------- .............. <br /> ­ ------- ------------------------- ---------------- --------------------------�':---------------------------------*------------------------- <br /> ----------------------- ------- : ------------------- - ------------- <br /> 0 ............ ------------------------------------------------ <br /> ----------------------------------------- ------------ ------------------------------------------- ------------------------ --------------------- <br /> FINAL INSPECTION BY:.._._ . L�--—--------------............ Date-------q---------- --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9 145446 ATWCOD <br />