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APPLICATION FOR SANITATION PERMIT Permit No. .___-_9__---l' <br /> c/ (Complefe in Duplicate) <br /> Date Issued -__2 G: 5 fP <br /> Applica-%n is hereby made to the Sart 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 CATION-:_-_-- - -- --- ---}- -- q_`�`r_------------------_-g � <br /> Owner's Name-------- - `-- I ---------------------:-­---_---P-h-- <br /> - --------------Pho---• ..-------•-•-- <br /> �-r---------- --------- <br /> Address---------=--- <br /> .. c'G ------------­­---------------- i <br /> ---------------•--------- ------------------------ ~ <br /> Contractor's Name_..__ �_ <br /> ---=----- - ---------------•---- ---��-- •=---:..---------• --------••------ '---•-----'-. Phone----•----------------------------- <br /> Installation will serve: Residence [4,--Apartment House ❑ Commercial.❑ Trailer Court ❑ Motel [I Other ❑ <br /> Number of living units: -1----- Number of bedrooms --j-0-0- Number of baths __/____ Lot size ___-_�7_5_~-K.--fQ-( <br /> Water Supply: Public system 9- Community system ❑ Private ❑' Depth to Water Table <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 0- New Construction: Yes:W No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta c: ante from nearest well--------------------Distance from-foundation---________________Material__--_____.__-__-____--__-______ <br /> ❑ of compartments------------- ---------4 Size--------------"- --------------Liquid depth--------------------_----Capacity--.-----= <br /> Disposal Field:' ,-Distance from nearest well----------------''Distance;from.foundation--------------------Distance to nearest lot line----------------- <br /> Elber of lines`--------------- Length'bf each line------------------- ----------Width of trench - <br /> Type of filter material_____________________ Depth3 of filter <br /> -- <br /> material_._- ---- - _ Totalength' _____._._____--_____�_______ <br /> --�-_--__---`Seepage Pit:- Distance to nearest well_-_--A/f7 dDistancefrom" foun(do4tion___.•--------Distance to nearest lot line------ <br /> RL Number of pits-_i_ _ _______________Lining material- n / - <br /> Dept ----------------_-.- <br /> i <br /> Ces❑spool: 5zeacfrom nearest.well-----------_-----Distance from foundation.-. Lining material-_-._-._.-._________.______-_-__.___.iDiameter---, <br /> - Depth------------------`. -•-------- ----------------' - Liquid Capacity-- <br /> r '- ---------------'----.gals. <br /> Privy: Distance from nearest well____-.- __ ______________-.______-- _..Distance from nearest building_.,_,_,,____--.-_--_-- <br /> ' ., ----- -------- <br /> ❑, Distance to nearest lot I ne-_--------------- ------------------------------- h' } <br /> :_... ----- <br /> �y r � <br /> Remodeling and/or repairing (describe)_____________________________________ � <br /> -------------- -------------------------•--------------•-------------------•"--------•------------------------ <br /> __ . 3 E .� y <br /> ___________________________________•-____________________ _------_________________..__-____--___________-•_____-_________________-_________-_______--_______-._____-__.___-__________-•--____-________.______________,-_-_- <br /> ____________________ .. <br /> ______________________ <br /> _________________________________________•_______..____.___________.__..__________________.._-_____________-__..____________.___-___-._.__-____-.-.__.__-____-. <br /> I hereby cert;_xthat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St , and rules and regulations of the San Joaquin Local,Health District. <br /> t <br /> (Signed)------ --- --------------- - ------------ -----=------------------------------------------------------ ---------( wner and/or Contractor. <br /> 1 <br /> BY: ------• ------* Z_ (Title} ------------------- -- --------- ------ Z <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reveise side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ !A.J --------------------- ------------------------------ DATC t <br /> REVIEWED BY ---------------------------------------•---------------- -- ------ DATE--•-a <br /> c,F ; <br /> F <br /> BUILDING PERMIT ISSUED -------------- ---------------------------------------------------------------------- DATE-- # J <br /> ---------------- <br /> Alterations and/or recommendations:`_________________________ <br /> -----•-• .._ <br /> ------- ---- ------------•-------•-----------•------------•---------••-----.------------•----------------------------------- <br /> ----------------------- - -----------------••------------------- --------- •---------------------------' <br /> FINAL INSPECTION BY:-- -' ' "'"`.. ------ Date. -----'---' .. . t..- <br /> =-- <br /> -------------- <br /> x SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street Bio North "C" Street <br /> Stock+ort, California Lodi, California Manteca, California Tracy, California <br /> Es�9 745446 ATwaoo r <br />