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APPLICATION FOR SANITATION PERMIT PArmit No. ___ '---- ­-­ <br /> c9�� <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica-lion 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 /> 51% nn <br /> JOB ADDRESS AN CATION------ ► S, - <br /> --------------------- -------- - ------------------------•----------- <br /> r C_ <br /> Owner's Name------ <br /> ---- -- - - � -�.X�C�-------------------- - ---------- ------------------ P1�eZ! ------ _Y-� 4- I <br /> Address.-------.:.. -----`� . -_.. ... <br /> Contractor's Name----- _.4.1' ./ --------------------------------------------- --------------------- •---•-----r------------ Phone-----------••---•-------••--------- �. <br /> Installation will serve: Resiclence`)2� Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ ___ Number of bedrooms ._5 Number of baths _+C_____ Lot size _'_�_.�___�f_`y�___________________ <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 ❑ .Adobeo Hardpan ❑ <br /> Previous Application Made: Yes ❑ No-J4 New Construction- Yes ,. No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted iff�public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well7 _ Distance from-foundation---Ab--------- Material---a-W..__ ._.__ <br /> "IN ___�_ _ Liquid depth Na. of com artments_____. ... Size_' _ .__.Ca acil ----___ _f.____ <br /> P - P. P Y <br /> Disposal Field: Distance from nearest we3 & ,,,,Distance from foundatioh---�__Q---------Distance to nearest I?t line___1�_____.__. <br /> Number of lines---- __ Le t�h�o,pf,each line___ _Q-------- of trench--__ <br /> Type of filter material4l_S1_.Dr/�ilier material.__.__ �.._...___Total length_____,�___� „�______________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_______________._ <br /> ❑ Number of pats----------------------Lining materiel-----------------------Size: Diameter-----------------------Depth--------------------_------------ <br /> Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-----------------._.-________________. G <br /> ❑ Size: Diameter------- -------------- ---- ----- - Depth-------- -------------------- - -- - ------Liquid Capacity..--------------------------gals. <br /> Privy: Distance from nearest well_____.__..___.f i_________________,______._.__Distance from nearest building-----------__-________________.___.______. <br /> ❑ Distance to nearest lot line--------------------- --------------- <br /> Remodeling and/or repairing (describe):---/ f_ 1 __,__- --.-. -------------------------------•---.-.----_--- <br /> ----- -------------------------------- <br /> . <br /> ------•------------------------- ------------------------,----•---------•-------------••--------•-•----•---------------------------------------•------------------------------------------------------------------------------- <br /> I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sts law and rules 'and regula ' ns of the quin Local Health District. <br /> 51 ned .._._____________________________--------Owner and/or Contractor <br /> t <br /> By:---------------------------------------------------------------------------------------------`:-------------------1---------------(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 , r <br /> APPLICATIONACCEPTED BY------ ----------- ----- ------ ------------------------------------------------------- DATE----- -�4�---------------------------------------------- <br /> REVIEWEDBY------------------------------------- ------- -----------------•-•----- ------------ DATE------------ ---•---------------------------------- <br /> BUILDING PERMIT ISSUED------------------- --------- --------- -------------- -•----------------------------------------- DATE------------- ------- `�� <br /> Alterations and/or recommendations:--- ------ ------ - - - ----------------------------------------------------- -------------------- -- ------------ ---- ----- <br /> --------------------- <br /> I------------------------------------------------------ ------ -'-------- -----r-------------- ----------------------- ------------------- ------------------------------------------------- <br /> FINAL INSPECTION BY:.------ _.��------------------------------------ . Date----- -------- l -- --- - ------------------------------- <br /> ---------------------- <br /> - t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-2M 145446 sTWOOD ,2-s4 <br />