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} <br /> APPLICATION FOR SANITATION PERMIT Permit No. ----- - <br /> I # (Complete in Duplicate) 9/ // <br /> Date Issued -----_r._I�/ <br /> Applica+-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereip de cro <br /> This application is made in compliance with County Ordinance No. 549. <br /> "�­rIL,�—twC*'J'D >v&/ e-"f ---.5, 0, <br /> , ��_ �e_ A;&_�. �, ?/,� W 4... <br /> JOB ADDRESS AND LOATION- <br /> Owner's Name ------- <br /> -------- �. ; - -- i-- - ---------------- Phone------------------------------------ <br /> Address Q _ t- �C" <br /> Contractor's Name---------••-• � . -- -------, Zf_,C.-•A�"------------ ---------------- Phone----------••--------------•------- <br /> Installation will serve: Residence Apartment Hose ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J_._ Number of bedrooms -l-_- Number of baths -,--- Lot size ---_,�- <br /> --------------------------_---------------- <br /> Water Supply: Public system ❑ Community system ❑ Private�pth to Water Table /0-_ ft. <br /> Character of soil to a depth of 3 feet: 1 Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No �ew Construction: Yes W'No ❑ <br /> STYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool-permitted if public sewer;is available within 200 feet.) <br /> Septic Tank: Distance from-nearest-well�i.1.o0------Distance-�from=found-tionf _= -Ma+er al--- =__ ,Ili __�_ <br /> ® No. of compartments-...2-----------------Size�S�,A-Y_X--.6----Liquid depth-------�--------------Capacity--�� _ <br /> Disposal Field: Distance from nearest weli//W----- <br /> .-Distance from foundation-.�0_-1--......Distance to nearest lot li9e_- 7-1 1a�y� <br /> R] Number of lines------L'9- 2�- Length of each line--------- <br /> --_-`� �______________Width of trench-..3Q_-- <br /> -- �� --------- ------- <br /> Type of filter material___151 _ epth of filter material...J_$--._-------Total length--------.TQ-_- _---..-.-. <br /> Seepage Pit: Distance to nearest-well------------------_..=Distance from foundation--------------------Distance to nearest lot line_-----..---__-.._ <br /> ❑ Number of pits----------------------Lining material------------------------Size: Diameter-----------------------Depth ---------------------------•-----4� <br /> Cesspool: Distance from nearest weld-----------------Distance from foundation-------------- Lining material-___.---_.----.-----.------_--.-_.--i <br /> El Size: Diameter-- --------------------------------Depth.---------------------------------------- ----------Liquid Capacity----------------------- •--gals <br /> Privy: Distance from nearest well----- -----------------------------Distance from nearest building------_-----------------------_._______--. <br /> ❑ Distance to nearest lot Iine----------------------------- ------------------------------------•--•------------------------------ <br /> Remodeling and/or repairing (describe)---------- ---------------------------- ----------------------------•---------------•---------------------•-------------------------•-----------•---•---- <br /> --- - •-------------------------------- --------------------•---------------------------------•- ---------------------•---------------------- ------------------ <br /> --------------•----...----------------------------------------- ---­------- ---••---•--------------------------•---- <br /> f <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la s, an rules and regulations of the San Joaquin Local Health District. <br /> -----� { ----------------------------------------------------------------- - <br /> (Signed]............:�: k ---_---- -___._._. � - _(Owner and/or Contractor) <br /> -- ._RYL-------------------•------------------------------ -- (Title)------------------------------------••------- ---------- <br /> _.�_. .-.���;.=.,- ter--�-_,�---__-----_--_:-___:-- --„_;-s;-� �._ .�.. .... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings etc.;can be placed on reverse side) T <br /> F©RDEPA-,ITMENT7USEON, Y <br /> APPLICATION ACCEPTED BY-. "t r DATE -.I - 17--•------------------- <br /> ------ -- -------------------------- DATE <br /> REVIEWED BY -- --- ------ ------------------- ------- ------ --- ----- ------------------ - - - -------..._..-•------- <br /> BUILDING PERMITISSUED---------------------------------------------------------------- ------------------------------------- DATE.--------- <br /> Aiterations and/or recommendations---- ---------- --- --- ----------------------------------•---------------------------•-•----••------------------------------ <br /> ---------- -------------------- ----------------------------- ---------------------- --------------•-------------------------------------------------------•-------------------------••-------------..--... <br /> a <br /> ------------------------------------ - -- •--------------------------------------------------------------------------------------------------- ------------------------------•-•---- •-------------- <br /> '4�� <br /> FINAL INSPECTION BY:...-- ` �y ------ ---------- Date---- .I------------------ --- - -------------------------------------- <br /> I • 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 I45446 AT 00. 12.59 <br />