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vvA --7 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ___ __ _.__ / <br /> (Complete in Duplicate) r-- -� <br /> Date Issued ___-- --------- <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. 549.E <br /> JOB ADDRESS A D OCATION----114--//r---------e-•------------//- - -- --• '"•------------------------------------------- <br /> Owner's Name.-WK - - ----- -------------------•---------------------- ------------- -------------------------------------------- Phone-------------------- <br /> Address..---.- - -- ---------------•--•----------------------•---•--•------------------------------------------------------------•-- <br /> ---------------------------r--- <br /> Contractor's Name--- A' "~ ---------------------------------------•--- -------------------------------------------- Phone =1• i ]* <br /> r Installation will serve: Residence Ao-�partment House,0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:,--/--- Number of bedroom1.s L Number of baths ---/-- Lot size --{�� X #_ <br /> } Water Supply: Public system ommunity system ❑ Private [I Depth to Wafter Table 4"ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: Yes ❑ No &-Pd' ww Construction: Yes — <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 "a--Distance from foundation__ ___ _._ _ Mate ial---d I W" <br /> I � No. of compartments-. Liquid depth-- _.-t-�-._.--Capacity_-_r-_-____-_ <br /> Disposal Field: Distance from nearest Distance from foundation___ ..f..Distance to nearest lot line__ <br /> Number of lines-------t______- Length of each line__wZ..,4' ..........width of trenck___2..Y---------------------- <br /> T . <br /> Type of filter material-_ _._. De th of filter material____ : Total len th__-__ <br /> ---------- <br /> 4ff <br /> Seepage Pit: Distance to nearest welly ____Distance f m fou ation___ Distance to nearest lot-line---C�__------ r <br /> Number of pits..... Lining material_ Size: Diameter_247----.--------Depth- -- ------------------ N <br /> Cesspool: Distance from nearest#well.................Distance from foundation---...................Lining material___-___._______..__.__._________ <br /> Size: Diameter--- --•--, =-`-_--.-.- - <br /> -----'-'-.Depth----------=------r' "' =Li uid-Capacity------- — als. <br /> Privy: Distance from nearest well______________ ____________________--_______._Distance from nearest build!ng._________.__.________________. <br /> ❑ Distance to nearest,.lot line-------------- ---------------------------------•---------------------------------------------------------------- _------------ ----- yjr <br /> Remodeling and/or repairing (describe):-------------------------------------- -------------------------••-•-------------------•---------------------------------------------------------------- 1S <br /> -----------------------------------------------------.-----------------------------------------•--------------------------•---•------------------------------------------ ---------------------------:----------------------- <br /> ------------•-•--------------------------------------•-•----•-----------•-••--•--•-----------•--------•--------------------------------------------------- ---------------•------•--------•---------------- t <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, State la s, and r les and regulations of the San Joaquin Local Health District. <br /> (Signed)_- ----------------- ------ ------------------------------------------------------------- Contractor] <br /> i- - _-&-i ---- ------- -------------------------­--(Title)--------------------------------------------- ----------------- <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 /> APPLICATIONACCEPTED BY--------------- -----•-------------------------------•--------------------------- DATE-- -------------=- ------ <br /> REVIEWED BY-------------------------------- -----Z DATE {�/ <br /> ---- - ------ - -- <br /> BUILDINGPERMIT ISSUED------------------i--------�� ;------------•_ -----------------------------------._ DATE--------------------•--7 j----------------------------- <br /> Alterations and/or recommendations--- ---------------------------------- --- -----------•----•---------- • __ ---------------------------------------------Sf........-----• ---------- <br /> --------------------•------------------------------------- ----------- ------ ------------ - .•--• -------------------------•----------------------------•--- <br /> ----�� _ -"- -.-�- ______ ______ __�i�._-----_� _.-______._______-.____......-_..."..-.._..-....__.._________._____•__- <br /> __________________________________________________________ i ye <br /> ¢ ■ <br /> _ -------------------"--. --------------------------_. ._.__.-__.----.....________.__.__.______._._._.____..__._.__________.________ <br /> 1 f <br /> FINAL INSPECTION BY:----------- __- <br /> -- <br /> / r.!Tj. - ------------- Date----------------1 l- ----tom- --- 5� <br /> • ----�--------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sfreat 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lod',, California Manteca, California Tracy, California <br /> ES-9-2M I45446 A7W00D 12-54 q <br /> V <br />