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I R- 15�/_ s. <br /> t -� — <br /> ` .APPLICATION FOR'.SANITATION PERMIT - Permit No. ------7.A.1-S---- <br /> °(Complete in Duplicate) Date Issued ______l``s_7_s� <br /> Applica{ion is hereby made to the San Joaquin Loeal Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with Cbuiity. Ordinance No. 549. <br /> e: <br /> JOB ADDRESS AND JOCATIO.K. ------------------------ ----------------------------------------------- <br /> Owner's <br /> ---------------------------------------------- <br /> Owner s Name.... -_----- ----- �,. Phone--', -•-------- <br /> , <br /> Address--_----------`—' -----------------=------- <br /> } , <br /> Contractor's Name_-----�____—l— mil----=-`�' :----=------------------ --- --------------------------------------- Phone <br /> Installation will serve: Residence ❑ Apartment H6use P5\ Commercial ❑' Trailer Court ❑ Motel ❑ vvOther ❑ <br /> Number of living units:,�___ Number of bedrooms -4--- Number of baths I---- Lot size -------G-_f -______!l._._�___ _ __..___._ y <br /> Water Supply: Public system Community system; Private ❑ Depth to.Water Table <br /> Character of soil to a depth of 3 feet: Sand E] Gra 1 Sandy Loam E] Clay Loam ❑ Clay"❑ Adobey Hardpan ❑( <br /> Previous Application Made: Yes E] No New Construction: Yes No ❑ "'�J 1l <br /> j 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 'f_e'1.�t Di tante from foundation-J-Q...---- ---Mate ial <br /> ---=------ <br /> No. of com artments_.._ __.Size__ Liquid depth-------___ _____ ___----Capacity--- _?�__Q ____� <br /> +. compartments <br /> Disposal Field: Distance from nearest well___.__P3s.4 Distance from foundatio __1-0--______-Distance to nearest to line----- <br /> Number of lines______ _______ ___________ ngth of each line.__._ Width of trench_� ___B____.__._________ <br /> //ss�� i 4 -------. a <br /> Type of filter materia �tQ7►filter material____: -�- -___.._.Total length__- _ ` ___°___________________ <br /> t Seepage Pit: Distance to nearest well <br /> .___..-._-- --------Distance from foundation--------------------Distance to nearest lot line__.________-___._ <br /> r <br /> ❑ Number of pits----------------------Lining material--- _----•-----------Size: Diameter---------------.-------Depth-------------------------------.- <br /> . ... Qess ool: Distance from nearest well-----------------Distance from foundation__._-_._.------..___.Lining material__._____....__.____.___.__________'5 <br /> -- _� <br /> Size:;Dia�neter • ==' Depth Liquid Capacity gals. <br /> Distance.from.nearesf.build�n`- -" <br /> Privy: Distance from nearest well___._... ._ ._ ---------.. 9 v=-- <br /> �- <br /> ❑ !�D.istance to nearet lot line ----- <br /> --------------------- ----------------------- ----------------------------- ---•-- --------------------------- <br /> Remodelin a /or repairing {descri4�e�: `_= -------- - - ----------'`=`.''_ ,.. <br /> --------------- ---------- -p <br /> �# <br /> --------------- ------------------- ------- --------•-------­-------­------••------------------------------- -------------------------------------------------------------------------------------;-- <br /> F I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin-County <br /> F ordinances, Stt1aws, ules ander a lations of n Joaquin Local Health District. <br /> Owner and/or Contractor <br /> (Signed ------- ( /sY° --- -- ------------- Tale(Plot plan, shot, location system in relation to wells, buildings, etc., can be placed on reverse side). <br /> r FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--•------------------ -- -------- -------- -- ..-------------------- DATE_ _--- <br /> REVIEWEDBY------------------------------•=---------------------- ------ ------ . --------------------------------- DATE---.-.-- ----- <br /> BUILDING PERMIT ISSUED-------------------------------------- ------- DATE-- '-------- ---- — <br /> 4 Alterations and/or recommendations:----- ------- --- - --- ---- ---------------------------------------------------- - ----- -• U_ <br /> a <br /> - ! ✓ —CSG t .. .: �------•- xx <br /> - <br /> l' ( <br /> �,rf-•- <br /> -- - ----- --- ---- ----- --- <br /> ! - <br /> FINALINSPECTION BY:.... .- --------------------- ---- 'D ------ -- ------------------------ ---- ------------------------------------------- <br /> SAN <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 145445 A7Wn0D <br />