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42-1 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ....74)...�1��. <br /> (Complete in Duplicate) <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 withCountyOrdinance No. 549. <br /> JOB ADDRESS AND OCATIO ..........a..p�_7.__:_ ,________ ____ <br /> ----------------------------------------------------------------- <br /> Owner s Name '- t--•----• - ------- -------------------------------------------------------- ------------------------------------- Phone-,'7l 1 <br /> .�.. . <br /> Address---- <br /> ............ <br /> -------••----------------------------------•--------------------------------- <br /> Contractor's Name--------- QJ. 0Q/l/►✓ -� - - ------ -----------------------•••------------------------- ----------- Phone Wvn?--��f"-•-7 <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Fr <br /> Number of living units. _ Number of bedrooms ._a Number of baths _o2Lot size ---7,."__X.../ a 8 <br /> Water Supply: Public system Er--60,mmunity system ❑ Private ❑ Depth to Water Table 4'_1ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 1 New Construction: Yes ❑ 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 from nearest weIIJ _ Distance from foundation-46____._._--.Mate�aL� ---------------- <br /> No. of compartments___.--02--_-__-.-__Size_:A—X,3------------Liquid depth_-__Y_.a------------Capacity.. a d.__ `' ✓ <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line................. <br /> Number of lines-----------------------------------Length of each line-----------------------.......Width of trench---------------------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length.......................................... <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 /> -____________-_----._•_-___•-.❑ Size: Diameter---------------------- ---------------Depth----------------------------------------------------Liquid Capacity-------....................gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------.-----------------------......... <br /> ❑ Distance to nearest lot line----------------------------------•------------------•-•-•-•---------- ----•----------•---------•-•-----•---•---•----- <br /> Remodeling and/or repairing (describe):------------------ ---•-----•----------•-------•-------•------------•------•--•---••----•------................................................. <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, State s, and ru n egulations of, the S7an <br /> ;JJZin Local Health District. <br /> --------- ------------ ---------------- <br /> - wner and/or Contractor)(Si ned)-••--••••-- <br /> ..... <br /> By:------------••--••......... ----- --- - - Title - ------------------------------------------ <br /> (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- _.___.__..__------- _. _ __--____- DATE_______________ � <br /> REVIEWEDBY---------------------------------- ------ ----- ------ --------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED............------------ ---- - - -- --------------------------------------------------------- DATE......I................................................... <br /> Alterations and/or recommendations:............- <br /> -----------------------------------------------------I.................. --------------------------------------------------------------------------------------•------....................................................... <br /> -------------------------------------------------------•---------------------------•----------------------------------------------------------------------------- ---------------------------------------------- ............. <br /> --------------------------------------------- <br /> ------------------------------------------- <br /> FINAL INSPECTION BY:-- -tY-r---- ------- Date.--- g <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 /> ES--9-2M 145446 ATWDOD 12-54 <br />