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IN. APPLICATION FOR SANITATION PERMIT Permit No. --P-0 <br /> (Complete in Duplicate) <br /> _ Date Issued _..y��,,�s:�• <br /> �'Appllica4-ion is hereby madeto 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 AND LOCATION-----------Q.----------. - - ----- a*" <br /> ...._... <br /> ------------------- <br /> �.1` ./ .. �.'►.�Q � --� Phone................. <br /> Owner's Name__"__.__. ------- <br /> •------------•----------------------- ------•--------•--------•--------- <br /> Address...._... . P�' <br /> Contractor's Name-_.- -- <br /> Phone,;... w <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> 9 �.__ Number of bedrooms _-5-- Number of baths/ Lot size ...... <br /> Number of liven units: ._ <br /> Water Supply: Public system Q Community system ❑ Private J:J�epth to Water Table-:5-4 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay;L•gtim�❑ Clay ❑ Adobe. Hardpan❑ <br /> Previous Application Made: Yes ❑ Nom New Construction: Yes 0—No <br /> ] <br /> _tea <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if publ' sewer is available within 200 feet.)( <br /> Septic Tank: Distance from nearest well. Distance from foundation---/a."--------Material....C'_�� �/...... <br /> Size-"t'�� _14--Liquid depth .._- .l?._........-.Ga ace _ /Gds-.-_-- <br /> No. of compartments_.__ p <br /> i <br /> • 7 Distance to nearest lot line..... <br /> 3 <br /> Disposal Field: Distance from nearest well....___.-.._-.Distance from foundation... - <br /> Number of lines---•--••-•�-- .. .. . Length of each line-------Y7_5--.-.-`-e....Width of trench------�--------------------- <br /> Type or filter material..`- .�T-`t!Depth of fi4ter matenaL....__ !$.__�-r�otal length-------- --------•---------------- <br /> r �3.._..Distance to nearest lot line._--`'�- ___� <br /> ' Seepage Pit: Distance to nearest well.�/�Q.__"-:Distance from foun anon..-._ <br /> Number of pits._1.!..............Lining material__ ._!�`-`_: Diameter-_57 .....•••_•Depth...- �J�---------_-- <br /> Cesssppool: Distance from nearest well-----------------Distance from foundation....................Lining material----------.------___.---------.__. L <br /> ❑ . <br /> _ <br /> . <br /> . <br /> . <br /> . .De -- <br /> th--------------- -- ---- <br /> ------- ----------- ----------Liquid Capacity------ -------gals. <br /> Size: Diameter_........--- ---•- P <br /> Privy: <br /> Distance from nearest well---------_-------------------------------------Distance from nearest building............_"•.....-_._-_-_.__-...._.---- � <br /> ❑ ,. . : Distance to nearest lot line---------_------------- --"-...--•-----•----------.....------...................... - <br /> Remodeling and/or repairing (describe):....................---------------------------------------•-------------•-•----...._.__--------•----------------------- <br /> ` -------••-------•---"-----•----------•-----.................................................... <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 /> te s, a d rules and regulations of the'San Joaquin Local Health-District. <br /> ordinances, Sta <br /> ....(Owner and/or Contractor( <br /> (Sign <br /> ------------------------(Title)..•._ <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.....................__.. __,___ . <br /> ---------- DATE-----• = - <br /> REVIEWED BY.............;...--.......-_...._............._._.. . <br /> DATE----- --------- •--------------------------- <br /> DATE......................------------- -•------------....----- <br /> BUILDING PERMIT ISSUED................................ . ---_----------------------- ---- -- <br /> ---- ------ . - <br /> Alterations and/or recommendations:-----------------------° = .......•--•------------------------------------------- <br /> kk <br /> ------...... <br /> �. ........-------------------------------- <br /> --..._..------------ <br /> ---------•- - _ <br /> FINAL INSPECTION BY:...--- -- ------- •------------------ Date--- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sheet 300 West Oak Street 132 Sycamore Street 814 North "C"Street <br /> Stockton, California <br /> Lodi, California Manteca, California Tracy, Caiifornia <br />