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\S, <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued ___//Z/. <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 /> k This application is made in compliance with <br /> /County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION----------�f. --..------ '-� =---- ------�- <br /> // <br /> /� S_ �t/ -. '' -- Phone ------ <br /> Owners Nam ------- �' _ -------... = ------------- ------ - <br /> v �-• ,�-- <br /> Address -i. ---/ -- <br /> Contractor's Name------------V------------- -------------- -------- --------------------------------------------------------- Phone­ --Z,- __,�-•- <br /> Installation will serve: Residences Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -Z--- Number of bedrooms .�___ Number of baths _-/___ Lot size -------��_ ___-_____.__._ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- 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 ❑ Nod New Construction: YesVi No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 9. <br /> ;Septic Distance from nearest well..:.............-Distance from foundation--------------------Material---------------.-- __-__.____.______._._____- <br /> f U © No. of compartments-- --------- <br /> --------------Size_------------------------------Liquid depth--------------------------Capacity----------------------- <br /> I' �C <br />' Disposavi�l� Distance from nearest well.................Distance from foundation----------------.-_.Distance to nearest lo} line---------........ <br /> © � Number of lines-----------------------------------Length of each line-:..........------------------Width of trench----------------------------------- <br /> Type of filter material--------------------------Depth of filter material----------------------- g <br /> --Total length. •-•-•--------------------------------- <br /> Seepage Pit: Distance to nearest well �t�--___Distance f m foundation__= Distance to nearest lot line_--../____ S' <br /> Number of pits--_.1 ___Lining material__ .:��-_.Size: Diameter_____. Deptn.-=__- �_..__ <br /> v <br /> Cesspool: -"Distance from nearestwell:__--__'"Y:-_,-Distance from foundation___________________Lining material ------------------------ 1 <br /> - ❑-..- -_ Size.: DiarnAfier �_ � t De.p0__ -W_. Lictuid Capacity= -: ... .:� __gals., �, -4 <br /> Privy: Distance from nearest well------------------1k------- ._.____...._Distance from nearest building____________________________-.________._. <br /> ❑ Distance to nearest lot line-------- -----'--- -------------------------------- '--------------------------------------x�ft------------------------------------- J i <br /> Remoddescribe :---._._ ____ __._ ____ _ <br /> + <br /> ______ <br /> -------------------------------- --- f--------------------------------- -------- ------------- <br /> �. - ------------------------------ <br /> = -- - - - -- - <br /> ---------------- - <br /> -- <br /> - ------------------ <br /> - -------------------------------------- ---------• ---•------------------------------------------------------------------------------------------ --------------•=----------------------------------------- <br /> I <br /> ------•----------------------- --------I <br /> hereby certify that I have prepared this application and diet the work will be done in accordance with San Joaquin County <br /> 'ordinances, S e aws, a a <br /> 'orr es and-regulations of the San Joaquin Local Health District. <br /> (Signed) �i---- --A-Z--------------------------------------------------- -- - -------------------------------------------- ---------�-(Owner and/or Contractor) <br /> By:. •"/I �J- = --------------------------- --------------------- ------------------------(Title)-------- ...............--------------- <br /> (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be plact"d oVe'verse side). <br /> iF R DEPARTMENT USE ONLY <br /> I APPLICATION ACCEPTED BY DATE - <br /> ------------------------------------- <br /> IREVIEWED BY-------------------------------- ------------- ---------------- -------------------------------------- DATE------------------------------------------------------------ <br /> iBUILDING PERMIT ISSUED----------------- ----•----•--•----------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:-------------------------------------------------------­------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------•----------------------­-------------------------------------------------------------------------------------------------------------------------------------- <br /> --- <br /> -----------------•-----•-•----------•--------•-------------------------- ----- ---------------------------------------------------•-----------------------•- -----------------•---------------------------------- <br /> ---------------------------------•------- ------ ------------------------------------------------------­­--- ----I----------------------------- •--------------------- ------------------------------------------------ <br /> FINALINSPECTION BY---------------------- ---------------------------------- w Date--- -----/----- - --- -------------- ------------------------ <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 146446 ATWOO❑ 12-54 _ <br />