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APPLICATION FOR SANITATION PERMIT Permit No. .7 <br /> _q.2- .jq.� <br /> ---- ..... <br /> (Complete in Duplicate) V-3d x Z <br /> Date Issued ----------- <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION----- ---------- - ------ <br /> ....i ------- --------------- -------------------------------------------- <br /> - <br /> Owner's'Name--------6L <br /> --------- ---- ----------------------------------- -- -- F------------------- ----- --------------------------------------.-. Phone <br /> .................... <br /> Address-----------------'-.0- A,1�-------TZ--------------------- <br /> I' Contractor's Name... -'I� <br /> I -- ----------------------------------------------------------------_-------------------------------------------- Phone r <br /> Installation will serve: Residence ' Apartment House E] Commercial F <br /> Trailer Court E] Motel E] Other <br /> Number of living units: -Number of bedrooms --;&. Number of baths __0__ Lot size ---------- <br /> ------------ - <br /> Water Supply: Public system E] Community system El Private' Depth to Wafer Table -1-LD ff. <br /> N <br /> Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loom E] Clay Loam ❑ <br /> Clay ❑ AdobeL,11,, Hardpan ❑ <br /> E] <br /> Previous Application Made: Yes No?� A F7]New Construction: Ye No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> r! <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest.we_(171!——------Distance from foundafio-n----------- Material <br /> El No. of compartments------------ Size--------------------------------Liquid depth--------- - ---------------- - ------- <br /> ----------Capacity-------;--------- ------ <br /> Disposal Field: Distance from nearest well------------- -Distance"from foundation------ -------------Distance to nearest lot line----------------- <br /> El Number of lines-----------------------------------Length of each line-----------------_------------Width of trench-----------------------_---- ' <br /> ------ <br /> Type of filter material-------------------------Depth of filter material----------- -----------Total length---..----.______________----: <br /> -------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to neares� lot line <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------ ----Depth--' <br /> m neai­E�st well- -------- <br /> Cesspool: Distance from Distance from foundation _./$C�Lining maferial_ -we <br /> Size: —-------------De2th------ <br /> i_quid qappc�4_�__�. <br /> Privy: Distance from nearest well-----------------------------------------------Distance from nearest buildin <br /> E 1 Distance to nearest lot line----------------------------- <br /> Remodeling and/or' re (clescr <br /> ---------------- <br /> -- pairing ibe):_Ap, <br />- <br /> ------------------------------_ ------------------------------------------------- --------------------/4�------­---------------- ---------------- ------------------------------------------------------------- <br /> - ------------------------------------------------------------- ---------------------------------------------------11-----------------------:-----------*---------------------------------*----------------------------------- <br /> -----------------------------*--------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------- <br /> I hereby certify that I have pre0ared this application and that the work will be done in accordance with San Joaquin County. <br /> lordinances, Sfafe)ars, and rules prid regulations of the San Joaquin Local Health District. <br /> (Signed)\... -- ----- ---------------------------------------------- <br /> ------:-------(Owner and/or Contractor) <br /> By:-------------------------------------------------------------------------------------------- -----------------------------------------(Title)----------------- <br /> ----------------------------------------------- <br /> -(Plot=Olan, showing,size,of,lot.-location-of.system-inzrelafion,+o:w6ils,,buildings,-efc-.-can,6e,placed.on-reverse-side)--i.- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------- - ------ <br /> DATE <br /> REVIEWED BY ----- ------- <br /> .................... <br /> - ---- ------------ ---------- DATE------ <br /> 4 ---- ------ ---_---------------- DATE----- ----------JBUILDING PERMIT ISSUED------------------- <br /> Aterations <br /> SSUED------------------ <br /> Aterations and/or recommendations:------------------- <br /> .r --- ------------------------------I----------------------------------------------------------- --------------------- <br /> -------------------------------------- ---------------------------------- ---------------- ---- ---------------------------------------------------------- ----------------------------------------I------------­----------- <br /> --•--------------------- ----------------- --------------------------------------------------------------------------------------------------- <br /> ----------------------------------- <br /> ------------------------------------------ <br /> ----------------------- ----------------- -------------- ----------- ------- -• ------------- ----------- ------------ ---------------------------------- --------------------------- <br /> ----------------------------------- --- -------------------------------- -- ----- ----- - --- ------ --- --- -------------------------:--------------- <br /> ------------- <br /> FINAL INSPECTION 'BY <br /> - ------------ <br /> ------ ----------- Date------ --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South America" Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> 115446 ATWOUG 12-54 <br /> A <br />