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r <br /> APPLICATION FOR SANITATION PERMIT Permit No. __- '.- <br /> (Complete in Duplicate) J <br /> Date Issued ----- <br /> ��ZO/,��-- <br /> %Wplicaa-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> 4Ap1 <br /> This application is made in compliance with County Ordinance No. 544. .23,' Q <br /> JOB ADDRESS AND LOCATION.. - -- -- - ----- ---- ------ --- ----------------------- - -------P" <br /> Owner's Name------ ------H , 1 <br /> ---- ------ -------------- --------------------- --- ---------------- Phone----------------------- ........ <br /> Address................---------------------- " = <br /> -------/' --------------- <br /> Contractor's Name ------------------------------•------------------------------------------ Phone----------------------------------- <br /> Installation will serve: Residence Apartment House Commercial ❑ <br /> P ❑ ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ....V Number of bedrooms ---- Number of baths _/---- Lot size _-___ _3_.J{--lv---- -------------- <br /> Water Supply: Public system bg Community system ❑ Private ❑ Depth to Water Table _______ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob,k Hardpan ❑ <br /> Previous Application Made: Yes ❑ No DK 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.) CJy <br /> Septir� Tank: Distance from nearest wel1.47)-<—Distance from foundation__�_6_or_..___._.Matef�l_______________ _ __ <br /> fes¢` P ------ $ize x `� ---Liquid depth-------`----- 001..__Capacity---- <br /> No. of compartments __ <br /> Disposal Field: Distance from nearest weli.�2 Distance from foundation---1Q---------.Distance to nearest lot linePrJ <br /> Number of lines---------.y_________ it <br /> _ ______Length of each line------------ of trench--------- <br /> Type or s filter material___&.______- epth of filter material___.___._ _------ <br /> ---_Total length_________________________ <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: bistance from nearest well_________________Distance from foundation_-_.__.___._._-._._lining material-_--.___-_..____-_-.-._-_____._ <br /> ❑ ..`� <br /> Size: Diameter--------------------------- ------ Depth---------------------------- -------------------Liquid Capacity----- ---------------------gals. - <br /> Privy: Distance from nearest well----------------- _..___._....____--_-_Distance from nearest building---------._ ------------------------- <br /> 171 <br /> _____-_-________-._--._❑ Distance to nearest lot line <br /> Remodelingand/or repairing (describe):------------------------- --------------------------•---------------•-••---------•-----------..--------------------------------------------------... <br /> -----••--•-----••--------------•--------------•--••--------•---•-•--------- ----------------•------------------------------------•----------------•---------------------------------••-----•---------------------------------- <br /> ------------- --------------------------------------------------------.-------•-- ----_-----------------------------..-------------.-_------------_-------_---.----_..-------------------------------------------------- <br /> I e <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St toe laws,and rules andregulation of,the San Joaquin Local Health District. <br /> (Signed] ;� ' ---------------------------- ------ ---------------------•------------------------------------------------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------------------------------------------------------------(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 /> t,j- --2_a/_5----------------- <br /> REVIEWEDBY --------------- ------------------ -------------------------------------------------- DATE------------------ <br /> BUILDING PERMIT ISSUED------------------------------ •-------------------------------- ----------------------- DATE-------------------- <br /> Alterations and/or recommendations----------------------------------- --- ----- -----------------••--------------- <br /> ---•------------------------•----------------------- -----------------------------------------------------------------------•---------------------------------•----------••--••---------- <br /> - ------------------------------- ------ ----------------------------- - -•------ ------- - ------------•------------------------------------------------------------------------------------•------------•----------- <br /> eork;&_ <br /> FINAL INSPECTION BY:. (!..-. --- ------ --------------- ----- Date-__--�-------/ ---_ 4.+.....-----------.... ------------- - <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 /> ES-9-2m 145446 ATWODQ 12-54 <br /> Y <br />