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K -7 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> iComplete, in Duplicate) Date Issued------ <br /> I ct 5foro a r 't to construct and install the work herein described. <br /> Applica`iOn is hereby made to the Son Joaquin Local Headlth Disfr' mi <br /> This application is made in compliance with County Ori ce No. AAF <br /> JOB ADDRESS AND LOCATION----- --- ---- ---- --- ------ --------- --------------------------------- <br /> Phone l _: <br /> ----------------------- ----------------------------------- ------- <br /> Owner's Name------- - - ------------------------- <br /> Address ------- ---------------- Phone <br /> --------------_---------------------------- <br /> --------------------------------- <br /> Contractor:,-, ame--- --------- Oth <br /> El Commercial [I Trailer Court [I Motel El er 0 <br /> Resi ence Apartment House <br /> Installation will serve: rooms Number of baths _/---- Lot size ---------------------------- <br /> Number of living units: /---" <br /> ------ Number of bed /----- X Depth to Water Ta61Q0/11_,T_t. <br /> Water Supply: Public system 171 Community system C] Private '- Hardpan El <br /> Character of soil to a depth of 3 feet: Sand [] Gravel.[] Sandy Loam [] Clay Loam 0 Clay 0 Adobe <br /> New Construction,o No' <br /> Previous Application Made: Yes El /)� Yes No C], <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool p publicis available within 2 00 feet.) <br /> permitted if sewer Maferi ------ ------- <br /> iti-on,/-49------- <br /> Tank- Distance from nearest well _-Distance from fQunda 41. <br /> Septic /_�*---Li6uid dep.th <br /> No. of corn pa rtme n1s...,?----- ------- ---- Capacity <br /> t <br /> --Distance from foundation_ . .......Distance to nearest lot <br /> est well- f <br /> Di Field- Distance from neartrench_-_._ ------------- <br /> Ispo _0-- - Length of each line-------- - -------Width of <br /> Number oflength-_____.__ ---------------- <br /> /---------- D,pth of filter materia------ Total -- <br /> Type of filter maferiail;,"_�t_ ------Distance to nearest lot line----------------- <br /> Seepage Pit: Distance to nearest well_.---- ---------Distance from foundation-- --------- 4 <br /> Lining material-----------------------Size: Diameter-----------------------Depth------ -------------------------- "I,, <br /> Number of pits------------------ 11� <br /> F1 _ -- . _Uning material___._...._________----------------•---- <br /> Cesspool: Distance from nearest well-----------------Distance from founclafion__. ---- --- - Liquid Capacity--_-----------------------gals: -,.... - <br /> F1 Size: Diameter---------------------------- --------Depth----------------------------------- --------------- <br /> - <br /> Privy-. Distance from nearest well.......... ----------- ---------______----Distance from nearest building__________________________________________I--------- -----------------6------ <br /> Distance to nearest lot line------ -------- ---------------------------- <br /> . ---------------------- <br /> --- <br /> ----------------------------------------------- ------------------------------------------------------------------ <br /> Remodeling and/o-r repairing (describe}------------- -------------------------------------------------------- <br /> .. ............------------------ ------------- -- <br /> -------------------------------------------------------------- ", ----------------------------------------- <br /> ------------ -- -------------------_-------- ------------------------------------------ <br /> ----------------------- -------------- ---------- ---------------------------------------------------------------------------- <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, St -laws, and les d regulations of the San Joaquin Local Health District. <br /> weer and/or Contractor) <br /> - ------------------------------------------------ ---Xd <br /> ------- - --- <br /> (Signedi,__---------- ----- --------- --------------------------- - ----------------- <br /> By:----------------- ---------------- ------------------------------------------------ -------- ----------(Title--------- ------ ------- <br /> system in relation to wells, buildings, etc., can be pl� on verse side). <br /> (Plot plan, showing size o 16 location of <br /> FOR DEPARTMENT USE ONLY <br /> ---- <br /> DATE ------------------ <br /> APPLICATION ACCEPTED BY------------------------------- ------------------------------------ -----------------I)ATE --------- <br /> REVIEWED BY------------------------------------------- DATE------------------------------------------------------ -= <br /> --- <br /> REVIEWED BY-----------•------------------------- <br /> PERMITISSUED---------------------- ---- ------­----------------- ------------- --------------------------------------------------- <br /> Alterations and/or ---------------- -------------------------------------------------------------------------------------------------------- <br /> ------------- - ------- ....... ------------------- <br /> ------------------------------- ------------------ <br /> ------------ ----- -------- <br /> ------------------------------ -------- -- <br /> -------------------- -- -- -------------- - ------------- <br /> ----- ----------- -----_------------- - ------ ------------------------ - <br /> ------------------------------------------- <br /> ----- -------- --------------- ------ -------- <br /> ----------------- <br /> ------------------------------------------------ -------- ------ -- ------------------V__----- <br /> 4 -­',_��-------- ---------------------------- <br /> FINAL INSPECTION BY:_----i _ .1 . <br /> Date---------------- <br /> SAN <br /> ate------9- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 814 North "C" Street <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 1. <br /> Stockton, California Lodi, California Manteca, California Tracy California <br /> 1-446 ATWODU <br />