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�\,o <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> 11 (Complete in Duplicate) <br /> Date Issued --_ _�,_��-Y <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 /> This application is made in compliance--with County Ordinance No. 549. <br /> 7 <br /> JOB ADDRESS AUILOCAT ONC = _ <br /> -- ' `; <br /> - ---�:---^---- <br /> !0 -r17o-z s <br /> Owners Name.- - • Phone-----------••- <br /> _ <br /> Addres: 4;�------- -------------------------------------------• --------•---------------•------------------------- ---------•------------- <br /> Contrac:tor s Name-_.--------------------------------------------------------------------------- -----------------------------------------------------------. Phone <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ M7 __ <br /> IP Other ❑ f <br /> Number of living units: --'---- Number of bedrooms _Z__ Number f baths ---I--- Lot size(?--- . -.- -`�"' ---------- <br /> Water <br /> ______ _ <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 ❑ No New Construction: Yes +[ No ❑ .I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> h <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> n, <br /> Septic nk: Distance from nearest wellS!__�!'�Distan a fro foun aion/lA_.-r�"'_:Mater'al -- ----------------------- <br /> r �- <br /> No, of compartments-----__- __.,_..__.Size,-�_X_ xC___Liquid depth--..-- __ Ca aci --- ---____ <br /> 0 /� p tY <br /> Dispo Field: Distance from nearest wel (C WAD nce from foundation__ -1��Distance to nearest 1pt lirfe �`�'4_y <br /> Number of lines--- Length of each line----__ t Lf` <br /> ----- =.....�. -- ��I .t VVid+h of trench �V� <br /> or <br /> Type filter materrei Depth of filter materia-.-...- - -- -.-r- <br /> - Total length------------ ---_______________ <br /> Seepage Pit: Distance to nearest welf----------------------Distance from foundation--------------------Distance to nearest lot line_.-------__-____ '1 <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------- Dept h..-._________---_________------- <br /> Cesspool: Distance from nearest well_---------------Distance from foundation_----_------------- Lining material---.---.------.--_____---------_----- rn <br /> ❑ Size: Diameter----- ------------------- -----------Depth- -------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line-------- ---------- - --------------------------•------------------------------------ <br /> Remodeling and/or repairing (describe)-------- ------------------------------ ----------------.------------------------------------------------------------------------------------ <br /> -----------------------------------------•---------•--------------------•---------------------------------------.-....-----------------••-------------•-•--•----------------------------•-•---------- <br /> -------------------------------- ---- -----------------------------------------------------•-•-------------------------------•-----------------------------------------------•---------------------------------------- ------ <br /> I hereby certify that I have pr are d this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Staf-e laws, and rules a diregulations of the San Joaquin Local Health,District. <br /> (Signed)--------------- ------- : ='=i'`— '1 = '---------------------- - ------------------------------------------------------------------(Owner and/or Contractor) <br /> By:------------------------- 'i "' <br /> �- ---- ------------------------------------------------{Title) •--------------------------------••---------------------- <br /> (Plot plan. showing size of lof,location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . ............. -------------------------------------------------- DAT6- ------------ --- -- <br /> REVIEWEDBY------------------------------ _ #� ---------------------------------- - -------------------------------- DATE_ <br /> BUILDING PERMIT ISSUED----------�J_`-------------------------------- ---- DATE.- ` :.. <br /> Alterations and/or recommendations:----------------------------- <br /> -----------------------------------------I--------------------•------------------------ --------------------- --------------------------------------------•----------------------------------------------••------------•----- <br /> -------------------------------------------------------------- ----------------_---------------------------- -------------------------•-------------••-•-----------------•--------••---------------------­------------- <br /> ----------------I---------------------------- •-----------------------•---------------•------------------------------------------------------------------------------------------------ ----------------------------- <br /> --------------------------------------- --------------------------------- ----- ------------------------------------------- -------------------- ----------------------- ------------------------ ---------------------------- <br /> FINAL <br /> - ------ <br /> FINAL INSPECTION BY:---G ---1,01 6--_1Date. --J-Q `J` <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_.SM 145445 ATwoon 12-54 <br />