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CA <br /> L9 APPLICATION FOR SANITATION PERMIT Permit No. ------ <br /> / L <br /> (Complete in Duplicate) <br /> Date Issued .- <br /> �plica-l­ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION_ _54------6-0-Ji-i <br /> Owner's Name-----&- ------K-•-----L`-: _ ---4-4-c-1V------- - ---- ---- ---------- ---------------------- Phone------------------------------------ <br /> Address-.--.-------- -------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name----- ef--s--ox�---------------------------------------------------------- ---------------- Phone----------------------------------- <br /> Installation will serve: Residence � Apartment House 0 Commercial E] Trailer Court 11 Motel ID Other El <br /> Number of living units: ---/--. Number of bedrooms __eZt_ Number of baths A---- Lot size ----- ---------------- <br /> - ------- <br /> Water Supply. Public system [I Community system El Private g. Depth to Water Table AeOft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay El Adobe E[ Hardpan E] <br /> Previous Application Made: Yes E] No 91_ New Construction: Yes 4, No 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 /> �� f compartments----- --- --- - ----- - --Size---------------------- --------Liquid clepth--------------------------Capacity------------------ <br /> Disposal Field: Distance from nearest well----;_70__1__Distance from foundation......:5---7____/___Distance to nearest lot line-----Z6...1... <br /> Number of lines___.____.____ - 0* <br /> .L--?-----------Length of each line-------7-5-1-----V-Width of trench------- <br /> Type of filter material-J. .......5-k-Depth of filter material------/--!t........Total length-_-____ ----------_-_-_-.- <br /> Seepage Pit: Distance to nearest well__AtOJ------Distance from foundation______ 0 Disfance)fo nearest lot line--.J----. d / <br /> - ------- <br /> Number of pits------J.............Lining material__ Size: Diameter__ .._._____Depth.____ Q------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------------.-.--Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line-------- ------------------------------------------------------------------------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe):---------j---------------------------- -----------•----••--=------••---------•---------------------------------------------------------------------- <br /> ----------- <br /> describe):-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------• .........I---------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------- ------------------------------------------ ---------------------------------------------1-11---------I------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County <br /> ordinances, SfateAllaws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----- <br /> • ---- ...........T*__ _,s xflliz.� ---------------------------------------- ------------------------(Owner and/or Contractor) <br /> By:_._�----------__ ------ 4A1-,-C41, ----------•(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--------e <br /> REVIEWEDBY------------------ -------------------------------­ ------------------------ --------------------------------------------- DATE-----------'---- <br /> S;t ----------- --------------------------- <br /> BUILDING PERMIT ISSUED---------------------------- -------------------------------------------------------------------- DATE------------ <br /> Alterations and/or recommendations---------- - --- - --------- -------------------------------------_ <br /> ---------------------------------- --------------- -----------------^-- - <br /> ------ ­ <br /> ---------- - <br /> -a_ ------- -_-L4---------------------- ------*------ -- -------------------------- <br /> --------- -------- - ----- ---------------------------- <br /> ----------- ----------- ------- - ---------------------------------\4-------------------------------------------------- ------------------------------------------------------------------------------------- <br /> ------------- ------------------------ ---------------------------- .......I--------- ----------------------------------------------- ----------------------------------------------------------------------------- ------- <br /> - -------------------------------------- <br /> FINAL INSPECTION BY:.__�--- .. .....!�------------------------------ Date------- --- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfrsaf 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E!:--g 145446 ATWDMD <br />