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'h1�y APPLICATION FOR SANITATION PERMIT Permit No. ___-/._ . <br /> (Complete in Duplicate) Date Issued <br /> Application is hereby made to th n Joaq in I Health District for a permit to construct and install the work herein described. <br /> ------- - f- ,. <br /> - r <br /> is application is made in cam ian with u y r inance o. 544. 7 <br /> r <br /> JOB ADDRESS AND L CAT ON__ __ __________ _ JY <br /> Owner's Name--- --- -- -•----•--• :.-- ----•- - --------------- - - ----------------- --------------- Phone------------------------------- <br /> Address------------- r' _ --------------------------- -------------------------- <br /> Contractor's Nam ----- -- -- � --- ------------------ ---- --------------- ---------------- Phone�TU_ , <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other F]- <br /> Number of living units: __/.. Number of bedrooms _- umber of baths -/- Lot size _- f___�__-—---- <br /> Water Supply: Public system ,Community system ❑ Private ❑ Depth to Water Table 3e ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay .ea 51 ❑ Clay ❑ Adobe ��rdpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ .J � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i <br /> o septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se ' Tan Distance from nearest weft-...............Distance from foundation--------------------Material _.._____.__._.-____-----.._________..___.-___-. <br /> ..-� No. of compartments------- ------------------Size_--------------•----------------Liquid depth--------------------------Capacity---------------------- <br /> D iel Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line----._.__________ <br /> ' Number of fines-----------------------------------Length of each line----------------------,._-----Width of trench----------------------------------- <br /> Type of filter material-------------------------Depth of filter material----------------------- length________._________.___________-__�-� <br /> Seepage Pit: Distance to nearest well r�� ___Distance fr `fo�'dation___,,�-0_�_.Dista e to nearest lot line______-g __ <br /> LI �t �O <br /> ©� Number of p;fs..-.-,-/------------Lining material-_ __.Size: Diameter__.__ _-- .__.____Depth__._..._______:'____-.__-__- <br /> Cesspool• Distance from nearest well-----------------Distance from foundation------------------- Lining material-------.------._--_-.-________.______ <br /> Size: Diameter------------------ -----_De th------------------------------ ---.--------Liquid Capacity --------gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building.___.____.__.___________-____-_.-____.._. v <br /> ❑ Distance to nearest lot line-------- ------------------ -------------- - -•---•----------------- -------------------•-------------------------------------------------- <br /> N <br /> Remodeling and/or repairing (describe):--------- ---------------------------=---------------------------------------------•-•-----------.--------•----------------------------- ----------- <br /> -------------------•---..H__.----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------•--,---•-------------°a-�----------•-=-•=•,..--•------------------..._..._ ------------------........................---•- ......................•--------------------------------------------------------------- <br /> -------------------------------- = ----`---------- "" '; '�r"-` '-----•------------------------------•-----------•-••-------------- ------------•--------------••-------- ------- -------- ------ <br /> RIP <br /> I hereby certify._t 'have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat, i s,-and rules F[yg1jhd1g9kN*b j, of the San Joaquin Local Health District. <br /> �,� Sept'sc Tank Service <br /> " , <br /> (Signed) �x` ?.±?F Sa__c'c �. d�� sr?.23t?-4fz- _W„-- -�'�"op Contractor <br /> Stockton, Calif. <br /> BY� ------------- -------- :---------------------------------:---------------------------puilld�iings, <br /> (Title} `d" ----------------------------------------- <br /> (Plot <br /> - - <br /> (Plot plan, showing size of lot, location of system in relation to wellsetc., cyan be placed on reverse side). l <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED $Y- ------------------------------ ----------------------------------------------------------- DATE_ --------•------------- ----------------------------- <br /> REVIEWED [3Y------------------ --------------------------------------- ------ ----------- ------------ DATE--- <br /> BUILDING PERMIT ISSUED -- ---- --------------------- --- DATE.. ---Q------------------------------------- <br /> Alterations and/or recommendations- ---------- - ---- --------- ----- ---------------------------------------------•------•-•---- ---------------------------------- ................ <br /> --------------•---•------------ ----------- - -----•-- --------------- ---- - --------------------- --------------------•-------------•-----•---------------------------•-•----------------••--------------------------•--- <br /> ------------------------------ -- ------------------------ --------- -- ----- =---------------- --------------------------------/------------------------- ------------------------------------ <br /> FINAL INSPECTION BY:---------i�� -. ------------------------------------- Date----- I --``----`-------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOMD ­S4 <br />