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0, 777 <br /> APPLICATION FOR SANITATION PERMIT Permit No. -6..2-1...... <br /> (Complete in Duplicate) <br /> 1� Date Issued <br /> �XA plica4-ion is hereby made fo'fhe Son Joaquin Local Health District fol' permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance <br /> No. 549: <br /> J08 ADDRESS AND LOCATI N_ a-ct-_�/-/ ----------e�---------- -------A--y-----------------------------------------------­--- <br /> Owner's Name-4-?t-1 ..0!------- "i <br /> --- --- ---- -- ----:----------------------- ---il------- -----------------r----------- .............. Phone--------- <br /> ---------------- - <br /> Address----------- -------- ir <br /> -------------------- ---------------*--------------- -------------- ----------I-----------------------------------------I-----------------------I-------------- <br /> c - -----fttvnc?-&-� - -------------------- ------­--------------- ---------------- ------------ Ph..,Ak- rf7.24-1--4------ <br /> Contra -•------ <br /> Contractor's Name--,-- ii- ----------------------------------- <br /> Installation will serve: Residence 4- parfmenf House E] Commercial E] Trailer 'Court 0 Motel C] Other E] <br /> Number of-living units: __-I___ Number of bedrooms ­?--- Number 110f baths -4--- Lot size ----- <br /> ------------------------ <br /> Water- Supply: Public'iystem 4-j--ommunity system [❑ Private E] ''.;Depth to Water Table J.-A ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [-] Sandy Loam E] Clay Loam E] Clay (-] Adobe j!] .• arclpan E) <br /> Previous Application Made: Yes Ej No gf--N-ew Construction: Yes No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:- <br /> . (No septic tank or cesspool perrAiffed if public sewer is available 'within 200 feet.) <br /> T iii <br /> Septic Tank: <br /> Distance from near'est well__;__. ----------Distance from foundation--------------------Material <br /> No. of compartments------ -------- ----------Size--------------------(I-------....Liquid depth---------- <br /> f1 ­%, -------- -------Capacity--• <br /> Disposal Field: Distance from nearest well________________ Distance from foundation`_______...__-- Distance to nearest lot line_____-.__________ <br /> Number of lines----- ----------------------------Length of �ea'ch lline-,.-,------- -----------------Width of french---------------- <br /> ------------ <br /> -- <br /> Type of filter material----------------------- Depth of a ial-------------•----------Total length----------------------------------------- <br /> Seepage Pit: Distance to nearest'well/27,&--r� D <br /> -----Dist ce from 46 da ion----- -------Distance to nearest lot line--- <br /> �a- Number of pits.----I a __:- "' ....... <br /> ------------Lining ma erial" ize. Diameter­jR--"*-------Dep1h-.-.4J` <br /> 1k .... 1----------------------- <br /> Cesspool: Distance from nearest-v;ell <br /> -- isfanc foundation____ ___________Lining material <br /> ❑ Size. Diameter--------- ------------------_-------Depth----------------- ----------------------------------Liquid Capacity--------------- <br /> Privy: � -ON ­- ---------....gals. <br /> Distance from nearest well---" .' <br /> ---- ----------------------------------------Distance from nearest building________________________-_ <br /> Distance to nearesi lot Eine__ -------------- <br /> ------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):_____._._.___..____ . _- ­ ------------------- <br /> -----------------------------------------------------------------------------------------------------------------------------11--------------------------- <br /> -------------------------------------------------------- --------V, d� -L----------------------------------------------------I---------------- <br /> -----------------------------------------------------------2P-------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------ -- <br /> ordinances, State laws. and rules and regulation work w <br /> I hereby certify that I have prepared fhi!; application and that the A will be done in accordance with San Joaquin,County <br /> s pf the San Joaquin Lo6al Health District. <br /> (Signed)------- ----- - ---- -------- -------------- <br /> -------- ----- Is--------­---- --------------------------------------- ----- Contractor) <br /> By:— -------- --- ­ ---- -------- ----------- <br /> - ------------- ---- ------------------------ --------------- <br /> (Plot plan, s owing 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.._..___.____.____ --- ---- ----------------------- .1 ------------ DATE--- <br /> REVIEWED BY -------------------------------------------- <br /> --------------------------------------- DATE- <br /> ----- - -- --- --- --------------- --------- --x7 -- <br /> ---------------------*-------------- <br /> ----------------------- DATE--------------- <br /> BUILDING PERMIT ISSUED-------------------------------- --- -- -------- ----------- <br /> Alterations and/or recommendations---------------------- <br /> N;S�------ ------------------ -------------------------------------------------------- <br /> ------------------- --------------------- ---------------------------------- --------------------- 44;-----------------I------- <br /> ---------------------------- ------------------------------------------------------------- ------------------------ <br /> -------------------------------------------------- ------------------------------- ---- -------------------1�-------------------------------------------------------------------------­­------------------- <br /> -------------------------------- ---------------------------- ----------------- ----------------- ---------------i�-----------------------------------I <br /> ----------------------------------------------------------- <br /> ------------------------------------ ------- -------------------- ---------------- ----------------------------------------M <br /> -----------------------------------------------*----------------------------------------------- <br /> FINAL- INSPECTION BY:- --------------------- --------------- .......... Date------ ----------- <br /> -------------------- ............................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7� <br /> 130 South American Street 300 Wolf Oak Street 132 Sycamore Street 814 North "C', Street <br /> Stockton, California Lod;, California Manteca, California Tracy, California <br /> ES-9-2M 745446 A7WOOD 12-S4 <br />