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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued ---�/10_b%_ <br /> D es- 1 2-0 -37 <br /> Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application1 made in compliance with County Ordinance No. 549 <br /> JOB ADDRESS ANDATION._/_---------- I0 -- -C---- --- P4� . . . , z----- --- <br /> Owner's Name----- --------- ----I.. .... ....... 9----------------------------------1 ------------------- Phone - __m------------------------ <br /> --- --- - --------------- ----- <br /> 'I . 'V 4 <br /> Address Is . ------------------------------------------------------------------------- ------_------- <br /> --- ----- --6 ----------- <br /> -------------------- .....--- ---- <br /> contractor's Name............. ..... ---- ----- ---------t;:J1 4- ►Phone/_ 4-A!�7--- <br /> Installation will.serv'e.- Residence Apartment House E] Commercial E] Trailer Court L] Motel C-] Other E] <br /> ,Number of living units: Number of bedrooms3-'-. Number of baths %---'-'Lot size --; x Or <br /> ----------------------------------------------- <br /> Water Supply:jPublic -system 0 Comm uri ity'sysfe m El Privateo Depth to Water Table SD ft. <br /> .4 feet: <br /> Character of soil to ? depth — _. - -1 dobe Hardpan C] <br /> a th of 3 ei: �and F1' Gr�_4 E]'Sandy Ebam El Clay Loam Ej Clay E] A <br /> V- . ..A- L. <br /> Previous <br /> No <br /> re ious Application Made: Yes E] No New Construction: Yes E] <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-----------------Distance from foundation--------------------Material------------------------------------------------- <br /> No'. of compartments-------------------------Size--------------------------------Liquid clepth--------------------------Capacity_-------------------- <br /> Disposal Field: Distance from'nearest well_.-_-.._'..__--Distance from foundation--------------------Distance to nearest lot line-----_---------_. >1 <br /> aal7fvc,� Number of lines-------------------------T--------Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material-------- - --------------Depth of filter material----------------i--_.-Total length-_----------_-._.._-.--_---_..--_----_- •d <br /> Seepage <br /> ength------------------ ----------- ------------ <br /> Seepage Pit: Distance to nearest wellX_5V Distance from foundaitio' n_-45_�__v------------Distance to nearestI line_..-_-___ <br /> Number of pits-. -------.-Lining material--- Size: Diameter-3S- --------Depth-- ------ ---- 3 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-.----_.--.- .-- -------------------- <br /> Size: Diameter-- Depth-------------------0 --- D <br /> ----------------------------- --------------------------------Liquid Capacity----------------------------gals. T <br /> Privy: Distance from nearest well---------------_--- Distance from nearest building-_--_-.-_--_-.-__.--__._.._-.--_-_-------. <br /> ❑ Distance <br /> uilding------------------------------------------ <br /> Distanceto nearest lot-line------------------------------------I-------- ------------------- ------------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe):_ _7----------- -- ------------- ----------------f----------------------7-------------- <br /> -------------------- ---- -- -------- ------ ---------- ------- ------------------- <br /> -----------------I—--------------------------------------------------- ------ <br /> I -------------------------- <br /> -------------------------------------------I-------------------­----------------------------------------------------------------------------------------------------- <br /> - m - A V <br /> ------------•-•--------------••-----------------------------_---------------- ------------------------------------------------------------------------------------ -------------------------- ------------­­--------- <br /> I hereby certify that I have prepared this application and that the;fork will be done in accordance with San Joaquin County <br /> ordinances, Sta �elaws, a rules ianclregulat' s of the San Joaquin Local Health District. <br /> Fn <br /> (Signed)------------------------ - ------------ --------------- ------- -- --- ------- ------ <br /> ------- ---- ------------------ (Owner and/or Contractor] <br /> ------ --------- ---------{Title)------ <br /> - ------- --------------------- <br /> By:------------_......... ---- -- ----- ---------(Tif le)------ ---- ------------ <br /> buildings, etc., can be place reverse side]. <br /> (Plot plan, showing siz;��Iot, location of system in relation o wells, (�on <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- --- ------- -------------------------------------------------- DATE_.------:7<---_------------- -- <br /> - ------------------- <br /> ------------ DATE------ ------------- <br /> --- ------------------ ------------------------------ -­­-------------------- <br /> -------------------------- ---- ----- <br /> REVIEWED BY <br /> BUILDINGPERMIT ISSUED_-_-•----------------------------------- ... �r----------------------------------------------------- DATE---- --- ------------=------- ----:- <br /> Alterations <br /> ----------------------------- <br /> Alterations and/or recommendations:----4- --- ------------ --------------- ---------­----------------- ------------------------------ <br /> -1 - --_4 ------------------------------------ ------- <br /> -------------------1------------_-------------w.rr__%.. 7: 1�------- ------- ----- --- <br /> 4 JA, ---------------------------------------------------- <br /> - ----------------------------------------- <br /> ----------------------------- ---------------- -- ------------ ----------------------------------- <br /> ------------------------------------------ ------------------------------------------------------ <br /> -------------------------------------- ---- --------------------------------­-------------- <br /> �i-- - - 7 ----------------------------------------------------- -------- <br /> ------------------------------I------------------------------------------------ ---------------- ------------- -------------------------------- <br /> FINALINSPECTION BY--------------------------------- ------- ---------------------- Date-------- --------- -- --------------------------------------------------------- <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 /> E:5-9-2M 145446 AIWOnD 12-54 <br />