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�1 `S J <br /> �jy APPLICATION FOR SANITATION PERMIT Permit No. ___ .—-.—------ <br /> (Complete in Duplicate) <br /> Date Issuedfen ---.-- .----�------- <br /> Applicakion 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. '"" " <br /> JOB ADDRESS AND LOCATION D_ GV- =------------------------------------- <br /> / ( ----- ------- <br /> Owner's Name-------- .I.�•._f'L-_Y'0"Lt ` ��` -------- ---------- - -- -------------- P ane.- �--- ---�------- <br /> Address-. <br /> -•--- <br /> j <br /> Address-.-----•--. .. ± ------F•.... . <br /> ­------- -------------------------------------------- -----•------------------------------------------------------------------- <br /> ------ Phone----•----- �+ <br /> Contractors Name... <br /> '2`Y �- f <br /> Installation will serve: Residence Ft�f Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_E-_. Number of bedrooms .�2.._ Number of baths .f_____ Lot size __,-)----- ------------------------- <br /> Water Supply: Publics sterni Community-' system Private Depth to Water Table -------- ft. <br /> PP Y� Y � Y Y ❑ ❑ p <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe\4 Hardpan [3 <br /> ti Previous Application Made: Yes E] Nox 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 well__,___Q_-____-Distance from foundation-16.----- <br /> No. of compartments------ <br /> --------------Size_ :. _ --------Liquid depth----;4_-_------ --Capacity— <br /> �- _ Ca acitY <br /> Disposal field: Distance from nearest well.............Distance from foundation___._4-0_.---_Distance to nearest lot line.. _ ...... <br /> Number of lines-------�____-------------------Length of each line.-_---_(.1---------------Width of trench._:L.x_8__---..---..--_---__ <br /> Type of filter materials `JC_ n th of filter material....19V..........Total length-__ _�Irfin.-------------------------- r <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--.__._.______.. f <br /> ❑ Number of pits---------s------..-----Lining material-----------------------Size: Diameter-------'-------------.Depth-------------------_____.-- i <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------- ------.----------------------. 0 <br /> El Size: Diameter_ -------------------De th------• ---------------------------- --------.-Liquid Capacity_ -- gals. <br /> Privy: Distance Tr, nearest well___----------------------------------------------Distance from nearest building-----__.__-----___________--_._..___.__.. �r <br /> ❑ Distance to nearest lot line-------- --------------------•----------------- ---------------....-.._-.-•------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------- -------------------------------------------------------- A <br /> ----------------------------••----------•-----------------------------------------------------------------------------------------------•----------------------•--------•------------•-•-----------------------••----------- G <br /> ------------------------------------------------------------.---------------•-------•.......••--------------------..:........------------------------------------•-------------------------------------------------- <br /> - �. <br /> k I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Counfy <br /> ordinances,.State laws, and rule and,regulations of the San Joaquin Local Health District. <br /> (Signed)------- 1 ------ - - ------------------ ------------------------- ----------I-------------------,.-----------)Owner and/or Contractor) <br /> BY:--------•---------------------------------------------------------------------------------------------------------------------------(Title)---------------- --------------------------- ------------------ <br /> (Plot <br /> ------------- --- <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 /> APPLICATION ACCEPTED BY.... ........ _-- DATE------.- -� <br /> -------------------------------------------------------- <br /> ------------------------------ <br /> REVIEWED <br /> ------------------------- <br /> REVIEWED BY-------------------------- ----- - ------------------------------------ DATE----------- — ------ <br /> BUILDINGPERMIT ISSUED----------------- -- --- ------------------------------------------------------• DATE---------------- -•---`Y---------------------------------- <br /> Alterations and/or recommendations:-------------------- o <br /> -------------------------------- - -------- ---- ----------------------- <br /> --------------------------------- <br /> -- ----------------- <br /> ? - <br /> - <br /> �/ - /-------- ---------- ` _ <br /> r- - __.__"�'__.; ............. .............!�C__ L ._. ____ --- --- .. _ --- -___-._ ..- <br /> `-�'�1.�. _.__.__--_-..--------------------------------------------------. _--.-...-_-----.--.-_---__._-._.--_----. <br /> c <br /> FINAL INSPECTION BY:------------------ _ ' l — <br /> Date-- <br /> *, SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 4 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi,'California Manteca, California Tracy. California <br /> ES-9-2M 145446 ATWODO 12.54 <br />