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63 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued ---------- <br /> Applica4-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 LO N-------F.—P L- - ----------- - ------ <br /> Owner's Name-------------/ <br /> ame----------- - ----- - -- ----- - -- - ---- --- ---------------- --- ---- ---- ----------------------- . Phone..��... <br /> Address...­--------if----- -- --------- .. .... --- ---- <br /> • <br /> Contractor's Name------------ -- ---- ---------------------------------------------•-----------------------------------------------. Phone----------------------------------- <br /> Installation will serve: Residence eo'Apartment House ❑ Commercial [-] Trailer Court ❑ Motel ❑ Other E] <br /> living units: Number of <br /> Number of liv bedrooms Number of baths Lot size <br /> Water Supply: Public system E] Community system'Rg-�Fjvate E] Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E+--nay E] Adobe [I Hardpan E] <br /> Previous Application Made: Yes E] No eq—ttew Construction: Yes YR—Pto El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within' 200 feet.) <br /> Septic Distance from nearest well-914Tr-96D istance from foundation_-JIV.......Material ... <br /> No. of compartments-----------t�-----------Size- Liquid depth- -- ----capacif.y.-j------40-0-- <br /> Disposal Field: '-Distance from nearest well-IPLOIN-O'Disfance from founclaflon-_'Pa.___._.Distance to nearest�)pt)fe_40 <br /> - * W- <br /> Number of lines------- ----- tT <br /> ,"Length of each line Width of trench <br /> -------------------- <br /> . <br /> 'Type of filter material- Depth of filter-material__r ..........Tot al length----- - <br /> Seepage Pit: iDistance to nearest well_9&k.-UL---Distancjrom fc,,Adation_5__,0---------Disfanceto nearest IgLli ---- <br /> �Number of Its.-.--_/------------Uning material 414o,7_W_..Size: Diameter____ _ ________Depth_-_. <br /> Cesspool: <br /> iameter--- <br /> Cesspool: Distance from nearest well----------- 'CIT"roM Toundation--- -- --- ---------Lining material_-_------_--_---._.._---.__------_-_-. <br /> ❑ <br /> aterial_--------------------- ---------- -- <br /> El Size. D;ameter--------------------------------------Depth------ ---------------------------------------------Liquid'Capacify-.--------------------------gals. <br /> Privy: Distance from nearest weil- - ---------------------------------------------Distance from nearest building---------,------------ -----. (� . <br /> ❑ <br /> uilding---------------------- <br /> ------ <br /> ElDistance to nearest lot line-----------------------------•--- - ------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------- - ------ ----------- '41 51!111!t�f ------------------------------------­----------------- <br /> ­----------------------------I------------------------ ----- - l��� -I <br /> Z <br /> ------- -------- -- ------------------- --------------- ------------------------------------------------- --- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- <br /> ---------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws,jepdrules and req tions o the San Joaquin Local Health District. <br /> e <br /> (Signed). -------------------------------------------------------------------- -----(Owner and/or Contractor) <br /> By:--•------------_------------------------------ -----------------------------------------------(Tif le)---------------------------------------------------------------- <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 /> -------------------------------------- ------ -DATE____7V-------------------------------------------------- <br /> REVIEWED BY----------------- - ------------------------------------------- <br /> APPLICATION ACCEPTED BY.-------7:------------------------ -------------- -------- DATE------ -- ---\ ---------------------------------------- <br /> ------------ <br /> BUILDING PERMIT ISSUED.------------ --------------------------\ --------------------------------------------------------- DATE.----... <br /> ------ --__ <br /> -- _N <br /> Alterations and/or recommendations:------- ......... ---- -- ------ --------------------------------- ---------------------------------- <br /> -------------------- _11----M� ------------------------------------------------------ 4 <br /> - ----------------------- <br /> -------------------- - ------ &:-------- - ----------- ----- ---------------------------------__----------------------\j---------------------------- <br /> -----•-------------- �------------------------------------------- --- -­ -------------- --------------------------------------_------- --------------- ----------------------------------------------------- <br /> - ------------------ ---------------------- ---- ----- :------------------------------- ---------------------------------------------------------------------------------------------------- <br /> ---------------------- <br /> ----------------------------------- Date. ----------------- ------I--------- ------------------- <br /> FINAL INSPECTION BY--------------- <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 /> E5-9-2M 145446 A7WOCD 12'S4 <br />