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1 f ✓ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..... <br /> !�.v.-_ �� <br /> .(Complete in Duplicate) Ili, <br /> Date Issued ------ ---- ---s--.- <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 /> Owner's Name_-. -�` L <br /> ll G Phone --- -- ------------- <br /> Address-.. <br /> ------------ <br /> Address_.. - � --------------�-------�------O---- <br /> --- <br /> ----- :z ----•---------------------------- Phone- ----- <br /> Contractor's Name------------------------------------------- ------- o <br /> Installation will serve: Residence 2--Arartment House ❑` /Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _-,1-- Number of bedrooms _Y. Number of baths _.`___ Lot size _=!______________._ <br /> Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table�ed ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ <br /> Previous Application Made: Yes ❑ No dew Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �y <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> tic T Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- <br /> No. <br /> _.___-__--.-------- .--.----__.---_-._-__._.No. of compartments----- ------ --- -- -Size--------------------------------Liquid depth--------------------------Capacity---------------------- <br /> gsal field: Distance from nearest well_, '..Distance from foundation----1_�'__--_----Distance to nearest lot line----Z_4_+ <br /> Number of lines-------/............... Length of each line----i'°A6-'---_---_-_.-.Width of trench_-•Y-le"-_____._----__---_- <br /> Type of filter material ____----------- --------Depth of filter material-------------------- Total length-.-_.-_____--------__----___-_--__-_-__-- <br /> Seepage P : Distance to nearest well-_11- `�_ Distance om f undation---A Distance to nearest lot line--___,,.�_� <br /> Number of pits______ ____________Lining material_ ".__.____Depth..Z__6-----_ <br /> ......Size: Diameter ..__. ._.-_-___.__ <br /> Cesspool: Distance from nearest well-----------------Distance.-from foundation--------------------Lining material-_:------:--------------------------- %I1 <br /> El Size: Diameter------------------------ ...........Depth----------.----------------------------"-------_. Liquid Capacity ------------------gals. <br /> Privy: Distance"from nearest well--_---------------- _______.______-____._.__Distance from nearest building------------------------------------__._. <br /> ❑ Distance to nearest lot line- - -------- ----- --------- ------ - -------------------------- ------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)------------------ { <br /> -------------------------------------••------------------------.---------------­----------------------..---•----....._.-------.------------------------------ -----•----------------------------- <br /> ----------------------------------------- •----------------------''------------•-•-------------------------------------------------------•------------------------------- <br /> t-# <br /> I hereby certify at have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la d rules and re uI ior# f the San oaquin Local Health District. <br /> (SignSs <br /> ed)- __.__ _ _-__. Contractor <br /> gy:--------------------------------------------- -- ----- - ------- <br /> Z <br /> ---- <br /> ----------- <br /> (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc.,Ican be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- J �7 <br /> - - - -------- ---------------------------------------------- DATE---------- ---------------------- <br /> REVIEWED <br /> -----------------REVIEWED BY----- ----------------------------- ------•---------------------------------- --- ------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------- ------ -----•---------------- -------------------------- DATE---------------------------=---------------------•----------- <br /> Alterations and/or recommendations:.---------- = ....... --------•------------------•-----------•-•-----•-• -----------------......------------------------------------ <br /> --------------------------------------------- ---------------------------------------------------- <br /> - -- --- -- --------------------- ----- -- ------------------------ <br /> --------------------------- <br /> L, t <br /> J <br /> FINAL INSPECTION BY---- - ----- - --------------------------------------------- Date.. 7 - <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 ATWOOD 12-54 <br /> r <br />