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APPLICATION FOR SANITATION PERMIT Permit No. __..�3_Z_._-_--- <br /> (Complete in Duplicate) <br /> Date Issued -____ <br /> Applica-ion is hereby made to the San Joaquin Local Health District for 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------ lr� -----ci-`---------- <br /> --�NfiT _ _Owner's Name-------- - - - t ------ - -------------------------------------- Phone--------------------•---•-------•--- <br /> Address--------RZK-1 y7Q,X-------9-30- <br /> . -_1....-61A17A----C�_Z_�_11'_1��._�_t�.�.?��........ <br /> Contractor's Name...--- ------------------------ ---------------------------- Phone-`-"l---K-�l__4 07-- <br /> Installation will serve: Residence M__�Partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/___ Number of bedrooms __ Number of baths ---/-- Lot size ---7V_ -_ `_. _-�----------------------- <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 ❑ Adobe[-Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No E4- -- <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-------------------Distance from foundation------------------..Material-____________---------- _____________________. <br /> ❑. �►'S�r�YNa. of compartments---------- ---------------Size---------------------=----------Liquid depth--------------------------Capacity-_ ------__ - <br /> Disposal Field: Distance from nearest well_A/,0&_C Distance from foundation-------/-..?_.____.Distance to nearest lot line___' ~_--___ <br /> Number of lines--------------/ -.- Length of each line_____: _ ...............Width of french------4_-_,_ _________.____ <br /> !lS � i <br /> Type or filter material.__-E�---_-'_--_-._Depth of filter material-.-;J9_ _ _._Total length________ ------------------------- <br /> Seepage <br /> _._..__________________ <br /> Seepage Pit: Distance to nearest well- D _ Distance from foundation______TJ`!.-:.Di,�t nc��to nearest lot line_---�_-----_ <br /> [ � Number of pits____ _ ____________Lining material-__ il�'�`S. Size: Diameter-----_'��__-_.____-.____Depth____ .,�-------------- <br /> .--. <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--.-_-_-_____-______---_________-____-_._. <br /> ❑ Distance to nearest lot line-----------------------------I--------------------}-=--------------------------------------------------------------------------- ------ <br /> Remodeling and/or repairing (describe)_-W ------iL2. ' fx/--- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------- --------•------ ---•-------------------------------------- <br /> - -----------------------------------­­- ----------------- ----- ----------------------------------------------------------------------•----...--------- ------- -------------- <br /> I <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I ws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) /.P- 1 � �-- ------------------------------ -------------------------------------- Iner and/or Contractor) <br /> BY� d/� ... .. .. - - ---------------------------------------(Title)--.�ewa <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 /> -- ----- ----- ----- -----------------------------•---•------- ATE- ' >----- ---1� .. .._. <br /> APPLICATION ACCEPTED BY--- ---- ----- ----- ------------------------------------------------------------ DATE----- <br /> REVIEWED BYD <br /> BUILDING PERMIT ISSUED----------- " t--------------------------------------- DATE------------ <br /> Alterations and/or recommendations---------------- ...................................... ------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------ <br /> FINAL INSPECTION BY:. r -•------------------------------------------ Date /-� `------�---- --------------------------------------•---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Americen Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOOO 12-54 <br />