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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued �._./} -S <br /> Application t <br /> pl;calion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Is application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION.. <br /> ----7w------/?, -- ----------- - ---------- <br /> --------------�:- ----------- <br /> -------*------------------------------------- <br /> Owner's Name........._.C' L -- - -e. <br /> ------------------ ---------------- -- Phone.-/ -5 --r." <br /> ----------------------- <br /> Address <br /> -------Z?16 <br /> ---------------- ---_---------------------- <br /> Contractor's Name---------------------- <br /> ;- ------------- --- <br /> ------------------------------------------------------- Phonel-3 0-47 <br /> Installation will serve: Residence RE�`Aparfmeni House 0 Commercial d Trailer Court E] Motel El Other E] <br /> Number of living units: _/--- Number of bedrooms Number of baths Y... Lot ;size --- ------------------ <br /> Supply: Public system El Community system [] Private [Depth to Water Table,3P- ft.' <br /> Character of soil to a depth of 3 feet: Sand [D Gravel E] Sandy Loam E] Clay Loam'!E] Clay E] Adobe2-'Hardpan n <br /> Previous Application Made: Yes E] No P"- New Construction: Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> pfic.Tank: Distance from nearest well_------.._..___Distance from foundation-----------------.-Materiai---------------------- <br /> ------------------------ <br /> No. of compartments_---------- --..........Size--------------------------------Liquid deptl7i--------------------------Capacity----------------------- <br /> Disposal Prileld: Distance from nearest well..� _?�Iistance from founclaf -'.-.Distance to nearest lot line-.-/ <br /> Number of lines......-/---------- --------------Length of each line---.3 6 <br /> -------- ----------- --Width of trench----- <br /> -S 01/ Ll <br /> Type of filter maferial--3 jo-ctt___Depth of filter material----- -------.._Total length......F _*---------------------------- <br /> .f <br /> Seepage t Distance to nearest well-_ -.Q.0- --------Distance from foundation.__- Distance to nearest lot <br /> Number of pits-----/------------Li,ing mafe ria IA?A!L4f'_Size: Diannefer-MRw--------Depth....v7,O--------------------- <br /> Cesspool: Distance from nearest well.................Distance from foundation ------------- Lining material._--.........-...___......._-.-_..... <br /> El Size. Diameter------ -------------------- ---.Depth--------- ----------------------- -----------------Liquid Capacity- -------- ----------------gals. <br /> Privy:. Distance from nearest well------ ---------------------------- ____........_Distance from nearest building----------------------- <br /> El Distance to nearest lot line-----.-..- <br /> Remodeling and/or repairing (describe):------- ------------------ ----------------------------------------------............... <br /> ----------------------------------------------------------------- -------------------------------------------------------------------------------- ----­---------I---------------------I------------------------------------- <br /> -------------------------------------- ----------------------------_-------I--------------------------------------------------------------------------------------- <br /> ----------------------------------------------- <br /> ------------•---------------------------------------------------------------------------------------------------------------I------------------------- -------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> 'r <br /> ordinances,(f to certify <br /> and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)___ -------------------- <br /> - ------------------- - ----- (Owner and/or Contractor) <br /> By:-------------------------------- ----------------------------------- <br /> -----------(Title)------- ----------------------------------- <br /> (Plot plan, showing size of lot, location of sy�s+emn relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- ----------- ----- .... ----------------------------------------------------- DATE__'4_ <br /> .� <br /> REVIEWED BY ---------------------------------------------- <br /> - - ------------- ...... --- -------------------------------------- DATE------------- <br /> ----------------- <br /> -- -- ------- <br /> BUILDING PERMIT ISSUED------------------------------- -------------------------------- ------------------- DATE------- <br /> ------------------------ <br /> Alterations and/or recommendations:.- ------------ - ------- ---- - <br /> -------------------------------------- --- <br /> __\ --u------- :--------------- <br /> --------------------------------------------------------------- ----------------------- --------------­­----------------------- -------------------------- -----------------------I;t----------I------------- <br /> -------------------------------m---------- --------------------- ------------------------- -------------------------- ---------------------------------------------------------------------------------I-----------I--- <br /> --------:---------------------- -------------------------------------------------------------------------------------------------------­­----------------------------------------------------------------I------------ <br /> ----------------- --------------------- ----------------------------------I------------------- ----------- --------------- ------------------------------------------------------­----------------------------------- <br /> FINAL INSPECTION BY:- ----------- Date------ <br /> SAN �AQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 1, V 814 North "C" Street <br /> Sfock+on, California Lodi, California Manteca, California Tracy, California <br /> ES-3 145446 AT-D <br />