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r – <br /> ` <br /> (� APPLICATION FOR SANITATION PERMIT Permit No. ..,���__Yl--- <br /> (Complete in Duplicate) -7 / <br /> Date Issued ---.______.Sly--2 <br /> Applica{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. 4� �� A& <br /> . -L 55�i o .I o <br /> JOB ADDRESS AND LOCATIOKX06 .-. .d`__--------- > 1._.I_..��. ��6 _j <br /> Owner's Name-------- �..... �` "i ------- �-'��' �------------- <br /> �-•� - - -- --------- -------------- Phone------------------ ---------- <br /> ------- -- --- - <br /> Address-------------. ,) % �/�.�.�.1�1�/. � �' � / - = <br /> Contractor's Name- °- ------------------------------ ---------- ---------------------•----•------ Phone <br /> Installation will serve-. Residence ®, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/r <_. Number of bedrooms ___'- .. Number of baths .zTi%--Lot size ---- CF-b-__-----_- <br /> Water Supply: Public system ❑ Community system [R Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3•feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g-_ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Q-- New Construction: Yes g-No ❑ <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 ifrom nearest well...J4a.O---Distance from <br /> QC -- f-ou-ndation-__, ---------- <br /> No. <br /> ________No. of compartments--..__ --- ------------ --_-Liquid depth-----a6 teiria!_-_-.-�..'-.._(Capacity----1 <br /> -6-0 <br /> -0 <br /> -_- <br /> --- <br /> disposal <br /> Field: Distance'from nearest well---- a _._Distance from foundation{., - ..... ..Qistance to nearest It litre Ffi..__-.- <br /> r „3-_- Length'of eachAine---. <br /> Number ol.lines_..-..-- _ �G--�.� 4..�. ..�--....* Fdidth of trench-------�..�--a__----a..--- <br /> Type or filter material--- ___ s_ •Depth of filter material_.-__11--.___...Total leng}h._... .____----# <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 /> El <br /> aterial.- _...._-.__------..__......__------ <br /> ❑ Size: Dia - --------------------------------------- uid Capacity <br /> meter-------------- ----- ---------------.Depth_---------- Li <br /> � � q ---------------------------gals. <br /> Privy: 'Distance from nearest well------.---...---------------------------.-__....-Distance from nearest building-------------------------------- <br /> --- <br /> ❑ Distance'to nearest lot line------------------------------ -------------- -----------------•---- ------------------- --------------------- ------------------ -- ---- <br /> Remodeling and/or repairing (describe)--------------- ------ ----------------- ---•------------------------•--------- <br /> r <br /> -----------------------------------------------------------------------------------------------------------------•--------------...-------.--.•---------.---------------------------------•----------------------------------- <br /> ------------------------------------------••-----••----------------------------•------------------------•--•------------------------------------------------------------------------------------------------ ---- <br /> I hereby certify that I have prepared this application and-that the work will be done in accordance with San Joaquin County <br /> ordinances, St q <br /> laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----- -- ------•------------------------------------------------------- ---- ---(Owner and/or Contractor) <br /> ---------------------------------(Title)----- ' '"r` - ------------ <br /> (Piot 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 /> APPLICATION ACCEPTED BY.. DATE-,------------­-------- -------------• ------- S <br /> REVIEWEDBY -- ------ -- ----------------- ------------------------------------------------------- DATE--r_.7_.1 <br /> ---------------------- ---------------------------- <br /> BUILDING PERMIT ISSUED--------------------------------- -----------------------------------------------------------------.- DATE-----:- <br /> ]terations and/or recommen anon -----t--------------------------- -- - - -•-- - --- = _2 <br /> -- --- - - <br /> -------- <br /> r' s ' x. <br /> .. .. z. -..... _ <br /> __- <br /> .- <br /> s <br /> �'} ,,//�� j�/J -_. ------------ <br /> - <br /> -. -.. ... <br /> . ..................... .. ..�s�r. �.. QI.i ht^�.��......_..,.._._........._......._....._..__....-....._ <br /> FINAL INSPECTION BY:----------� ------------------ ------- Date- <br /> SAN <br /> ate SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 8130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "Cr Street <br /> µrte. <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9— M 145446 ATW000 i2-54 ,.p -- <br />