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/] APPLICATION FOR SANITATION PERMIT Permit No. ----.�Z-6-Q. <br /> t (Complete in Duplicate) 3/�3�- <br /> u` Date Issued ------ ---------- <br /> Ap Slica}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 /> JOB ADDRESS D LO ATION-•---/ -- --- <br /> Owner's Name----- --- - --•---------•---------------------------------------------_---------------- ---------.. Phone------------------------------------ <br /> Address........------ --------•- -- - -------- ------------------------------------------------------------------ <br /> Contractor's Name------ - ---x ---------------------------------------------------------------------- -------- Phone-�a <br /> Installation will serve: Residence Apartment House ❑ Commercial [I Trailer Court ❑ Motel [� Other <br /> Number of living units: _1--- Number of bedrooms - Number of baths ---t---- Lot size ------ ---X-1- <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 ❑ 4 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tan Distance from nearest well-------.--------Distance from foundation--------------------Material------------------------------------------.------ <br /> �i� <br /> No. of compartments--------------------------Size-------------------------------.Liquid depth----------------- ------ Capacity----------------------- <br /> osal Field: 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 _-------Depth of filter material-----------------------Total length------------------------------------------ <br /> T e o: iter materia-------- ---- -- <br /> Seepage Pit: Distance to nearest well-5167 L: ___.__Distanc from fouf�ation__/ ........---.Distance to nearest lot line---,/V------. <br /> Number of pits.___-t-___-________Lining rn erial�..�1y .Size: Diameter.--.�.---- ---Depth.-. -- --_----.-_------- ' <br /> Cesspool: Distance from nearest well-----------------Distance from.,foundation-----.------ lining material--------------------------- <br /> Size: Diameter-------------------------------------Depth-------- ------------------------------------------Liquid Capacity---------------------------- <br /> Privy: Distance from nearest well---------------------------------------------- ___Distance from nearest building.----.-------__---_-----------..-.-------. <br /> ❑ Distance to nearest lot line--------- ------ ---- ----- <br /> ------- --- --••-..-..--e------------ ------------•--------------------------------------- <br /> Remodeling and/or repairing (describe):-------- •--------- ---------•----•- --------- -----------------•-•------------------------- <br /> ----------------------------- <br /> --•--••--•----•-----•------------------------------------------------------------------------------------------------------------- 1 <br /> t � <br /> - - ----------------- ..------------------- ---­----------------- :------------------------------------------•---------•---.... ------------------------- <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed).-------- ---------------------- ----_-Owner and/or Contractor) <br /> ------------------- <br /> 'By:_----------- ----- ---- -- - - - - -------------------------------------------------------------------(Title)----- <br /> (Plot plan, showing si of lot, location of system in relation to wells, buildings, etc., can be placed on reve a side). <br /> FOR DEPARTMENT USE ONLY <br /> k <br /> APPLICATION ACCEPTED BY-- --------- --------- '�'-= ...................................................... <br /> DATE------ <br /> REVIEWED BY DATE <br /> BUILDING PERMIT ISSUED.-- ..-..- -------- �----=------------------------------------------------.- DATE----- - - '7�t -------------------------- <br /> .......... <br /> Aiterations and/or recommendations: <br /> -...---•-•-------•-------------•------- ----- --------- "! <br /> ----- <br /> --------------------------------------/ ---- — S ----------- - ----`(�S' -- <br /> ---------------------------------------- ---- ....-- •---•- ............ .........------ .................................................. <br /> ------------------I------------------------- ----------------------------------- ------------------------------------------------------------------------•----------------------------------- ------------------------ <br /> FINAL INSPECTION BY:... tet £.5--------------- --------------------- Date--- 3 - 5 <br /> ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California I <br /> E5-9-21A 145446 AYWUoD I.-54 <br />