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c APPLICATION FOR SANITATION PERMIT Permit No. ........................ <br /> Cox (Complete in Duplicate) Date Issued _ t'��1/� __. <br /> Applica-1-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 co pliance with County Ordinance o. 549. <br /> JOB ADDRESS AND LVk_ <br /> IqN_____ ----- <br /> �} r <br /> Owners Name--------------- <br /> �' /+�� ^ �`�- "�f-- ,..-�---- --------------------- ---------------------- Phone---- <br /> ---AdAddress- <br /> dress. =�-1C "`'----�' ----=.._�---- -- ---------- � �! <br /> Contractor's Name--- ---------------- !� � .eS ... -----�1` 7 Phone,!- --------------- <br /> a <br /> t � <br /> Installation will serve: Residence �A>artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> , Number of living units: _._. Number of bedrooms umber of baths __ -- Lot size �..-- -0.a__ ____ <br /> Water Supply: 'Public system �mmunity system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay E] Adobe We ardpan E]Previous Application Made: Yes El No �ew Construction: Yes ❑ No <br /> � <br /> OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> optic Tan V Distance from nearest well-----------------Distance from foundation_-.-----.-.-_-_--_.Material.-.-.--_--__.___--.--.-_--------__._-------- i <br /> ��- No. of compartments---------- ---------- - Size--------------------------------Liquid depth.----------- --- ---- - - Capacity----------------------- <br /> I Fi Id: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line--------....... <br /> .. <br /> Number of lines----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material-----------/1-------------Depth of finer maferial--------.--._------- 0fal length------------------------------- <br /> Seepage <br /> -------------------.-------.______-.__-• <br /> p g �7� '----Distance fr m foundation--_-./. ---- D• t Oce,to nearest lot line.--/-- <br /> See a ePit: Distance to nearest well__-__6______..__ -1 ------ <br /> Number of pits.______--..._..'-Lining materia4____ .__ _.Size: Diameter---- ��.-.F____Depth___ - -------------- <br /> Cesspool: <br /> _Cesspool: Distance from nearest well_________________Distance from foundation-----.--------------Lining material__-__-..---_-------.-_-------.-_-_-. (w <br /> ❑ Size: Diameter---------------- - --------------Depth----- ---------------------------------------------Liquid Capacity---------------------------•gals. <br /> Privy: Distance from nearest well-------.------------------------------------------Distance from nearest building-------------------------..--------------. <br /> ❑ Distance to nearest lot line -------------------------------------------------------------------•-- ------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):-------------------------------------- ------------------------------------ ........ ---------------------------•------------------------- <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, S#ate and rules v�le&u i�jof the San Joaquin Local Health District. <br /> Septic Tank Service <br /> (Signed}---.•...---- j - ----1�£►S-So:I"I�ra�o---I�JC�-�7�3�a�--- - ----------------••------------ ----------------------- Con#rector) <br /> Stack3on, Calif. - - <br /> By----------------=-----------••------------------------------------------------------ --------------------------•-------------------(Ti#le)----- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY, <br /> APPLICATION ACCEPTED BY--------------- --------- DATE------ ------ <br /> REVIEWEDBY------------------------- ----------_- -- ----- ------------------------------------------------------------- DATE-------------------------------------------------•------- <br /> BUILDING PERMIT ISSUED----------------------------- --- DATE._-------------- _ _ <br /> ---------- <br /> Alterations and/or recommendations:.---------------------- --- ---- -•-•-- -- <br /> ---.----•- <br /> --- -------------------------------------•---- <br /> ----------- ----------------------­- ------=--1.........__... ,....•. :} .......... ---•----•41---------------------------------- --------------- .......•-------_----- <br /> p <br /> -- <br /> ! -J----/ 7_ -fit -Ci +M <br /> -------- •----•------------••------•-• --•- --- <br /> ----------------- <br /> ------------------------- -----------­----------------- -- ------------------------ ---------------------------------- --------------------- <br /> /, � / -,;&-C <br /> FINAL INSPECTION BY:.-- .. �------------ Date---- - ------------------------- ---------------------------------------------- <br /> SAN <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 145446 ATWOOO <br />