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1 /VY <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) 7 <br /> Date Issued _____I/.3� _. <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. <br /> , <br /> JOBADDRESS ANDOCATION___.._ -l--_&...,5----- �F -------------------•-----------------------•-----------------------------------•- ---------- <br /> Owner's Name---- 3 --r-f--Y� ----- --•----- - --------- -------------- Phone_ ...-- ------------------- <br /> Address------0•�---� ---------1t._I. p ------------------------------------------------•-------------------...--------------------------- <br /> Contractor's Name------6-W -------------------------•--------------------------•------------------------------------------------ Phone----------------------------------- <br /> Installation will serve: Residence,`Eg� Apar'tment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:` -_I___- Number of bedrooms ,�____ Number of baths _I____ Lot sizeX-------- -__._________________ <br /> i <br /> Water Supply: Public system Community system ❑ Pri ate ❑ Depth to Water Table _______ ft: <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous•Application Made: Yes ❑ No,17 New Construction: Yes*�No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted 4f public sewer is available within 200 feet.) <br /> ID <br /> Septic Tank: Distance from nearest weII�P._Jif.�,,� <br /> Distance from foundation-.- ---._.__._Material_-_ <br /> No. of compartments----- --------- e -------Liquid depth. --Q----•-• <br /> Disposal <br /> Field: Distance from nearest wellW_b_)/®Distance from foundation_j_Q__r__._.._..Distance to nearest lot line-_•_. ��___. <br /> Number of lines___.____ __ <br /> � ----------- --------Length of each line----4--10-----------------.Width of tren�--.a--A---3-11--------------- <br /> Type or filter material�:e_!_c,__0QdUh of filter material---JZ__------------Total length_______ko--------------------------- <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 /> ___Liquid Capacity_ IX <br /> ❑, Size: Diameter-----'--"-�----------I-----------------Depth------------------------------------------------- 9 -----...--------------••--9als. <br /> Privy: Distance from nearesit well5________________--------- <br /> ----------------------Distance from nearest building--------------- ___-_-________..-.._._--_. <br /> ❑ Distance to nearest-lot line-----------------------------•------------------•----- -----------------------•--------------------------------------------------------- <br /> Remodeling and/or repairing (describe):__.__'4_`t---4V--- ------------------_------------------------------------------------------- <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 laws, nd rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--- 4 - ------------------------ -- ----------- ---------------------------------------------•-------------------(Owner and/or Contractor) _ <br /> B 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 /> APPLICATION ACCEPTED BY---------------- - --- -- -- ------------------- --------------`---------------------------- DATE-------->--- ----- <br /> REVIEWEDBY ---------------- ------------------------------------------------------ DATE-_ - -- - <br /> BUILDING PERMIT ISSUED---------------------------- --- -- ---------------------------- ---------------------_------------ DATE------------------- <br /> ------------ <br /> Alterations and/or recommendations:------------- -- - -------- -- ----------------------------------------------1----------------------------- -------------- <br /> -------------------------------•----------------------------- --------------------------------------------------------• --- ••--------------------------------• -------------------•----------------------------------------- <br /> --------------------- ------------- ------ --------------------------•------- ---- ----- -- ---------------- ---------------------------------------------------------------------------------------------- <br /> Lo <br /> � 1 <br /> FINAL INSPECTION BY:. � 5---------------------------------- Date- .... -o.....-� _� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street . 814 North "C" Street <br /> 'Stock+on, California Lodi, California Manteca, California Tracy, California <br /> En-9-2M 145446 ATWOOO 12-54 <br />