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r <br /> APPLICATION FOR SANITATION PERMIT Permit No. --------­-­---- <br /> (Complete <br /> --_---. ---.(Complete in Duplicate) -{� <br /> l Date Issued --- j- J(5 <br /> Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describi=d7-- <br /> This application is made in compliance, with County Ordinance No. 549. <br /> ------------------------------------------ <br /> j JOB ADDRESS ALOCATION t4----- -- --------- -- -- �-4O 0__ -. <br /> ' -------•------ ------------ <br /> Owner's Name. ,•- ----------------------•------•------ . ------------ - ---- -------- ------------------U--------- Phone------------------------------------ <br /> Address-----.......... ° `Tt... <br /> --------------..............------------------------------------------------------------------------------------------------- <br /> Contractor's Name------�- -- - -- ------A——-------------- ---•- - -------- ------ --- Phone-------------------- -- <br /> Installation will serve: Residence Aprtment House ❑ Commercial ❑ Trailer Court ❑ Mot . ❑ Other ❑ <br /> Number of living units: Z--- Number of bedrooms -- - Number of baths - -_ Lot size _-/F ---6,y-/Z- -------------------------- <br /> Water Supplyi-Public system ❑- Community system ❑ Private [Depth to Water Table - ft. <br /> Character of soil to a depth of 3 feet:' Sand Gravel ElSandy LClay Loam ❑ Clay F] Adobe ®Hardpan E]Previous Application Made: Yes [j No New Construction: Yesoam No ❑ <br /> ► TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> { P � P P P - - � 200 feet.) <br /> .' r <br /> Septic aoksa tic tank <br /> esfroml nearest permitted <br /> t b is se Dis#a availablef� � within ion -. <br /> eUti� / M a e i a l /J <br /> No. of compartments------.---- ---r----Size [ -Fx�� --Liquid depth---- .............Capaci#y-- � <br /> ���,�J, <br /> . Disposal Field: Distance from nearest we Distance from foundation o_��'r'"Distance to nearest lot�.in -- <br /> 1 - , ...-. <br /> ' Number of lines-----_---... !-----------Len Length"of each line----------.-2-�_ -�-.-. � <br /> ---- -- 9 � � � Width of trench----------- - � --�------- <br /> offilter material-,----- . --',V"�IJepth of filter,material--_-.__ .--.-Total length_--_----------- -------------- <br /> Type _---.- <br /> Seepage Pit: Distance to nearest well-.--- .--------Distance from' foundation--------------------Distance to nearest.lot line----------------- <br /> D Number of pits----------------------Lining material------------------------Size. Diameter-----------------------Depth----------------- <br /> ---------------- <br /> Cessp'ool. Distance from nearest well-----------------Distance from foundation.-.--------..-----. Lining material---.-.-----------------__-----------. <br /> ❑ Size: Diameter--------------------------------------Depth----------- --------------------------------- 1i---Liquid Capacity---------------------------gals. <br /> r. Privy: Distance from nearest well--- ----------------------------------Distance from nearest building-------------------------------------- .r; <br /> ❑ Distance to nearest lot line--------------------------------------------------------------•------ <br /> Remodeling and/or repairing (describe)-------- ----------------------- ----------------------•-•-------------------...-------..-..-------------•-------------------•-------- <br /> -----------------------•------------•--•----• --•---------------------------------•-------------------------------------------------------- •-----•--------==----------------------- <br /> F. ------------- -------•----•-------•---------------•--------------------•-----------------------------------------•----------------------------------------•-----------------------------...... <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.laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)•----1 •Z1----' -- -- ---------- Z <br /> -...--.(Owner and/or Contractor) <br /> By=---------------------------------------- ------- -------------------- ------------------------•---------- ---••(Title)--------------------- -------------------------- --------------- <br /> (Plot plan, showing size of lot, location of,tyl+em in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> i APPLICATION ACCEPTED BY ---------------------- ---------- --- -- ---------:------------------------------ DATE . ---- ------------------------------------ <br /> REVIEWED BY---------------------------- --- DATE__ <br /> BUILDING PERMIT ISSUED----- -•----------------------------------------------------------------------------- ---•-- --------- DATE----- <br /> -----------------_ Iterations and/otions:____-___---- --------- <br /> 4 <br /> l Je -rl-LL <br /> !�/ ssPwv_r fry r�7`,-f�._,.. j . <br /> ---------------- <br /> FINAL INSPECTION BY---------------------------------------------------------------- Date °'---------------------- ------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street Z84th "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> \E�E _2M 145446 ATwngo 12-54 <br />