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.A <br /> t <br /> APPLICATION FOR SANITATION PERMIT Permit No. _....J..6........... <br /> r ` (Complete in Duplicate) Dates <br /> 070-2-3 <br /> pplica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and ins Il the work herein described. <br /> pis application is made in compliance.with County Ordinance No. 549. E <br /> _ — <br /> )B ADDRESS AND LOCATION <br /> / t e;j� --..- . Phone............. ,............ <br /> wner's Nome-•-416, <br /> ► .r .............................. <br /> -----•-------...._..•--•••-•--...••••--•--•-•---•--•--••-••••........._..-•---•--•-•--••..................... `..._.. <br /> ��-� .. . .............. . Phon <br /> ontractor's Name_.. ..--_--•--._. -•----•--------------------------•--._...__...__._..... <br /> •stallation will-serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ tel ❑ Other <br /> Number of living units: �__.�Number of bedrooms_Number of baths ,�.... Lot size __._ _. '..`. .-"-"-•......• <br /> Water Supply: Public system ❑ °Community system ❑ Private @�—•8epth to Water Table <br /> +Character of soil to a depth of 3 feet: Sand ❑ Gravel 2f,­ssndy Loam❑ Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No }- "New Construction: Yes 4�;•—Pdtst T Y <br /> ' 'TYPE OF INSTALLATION AND-'SPECiFICATIONS:.,� �— <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tenk: Distance from nearest well./Dl1.......Distance from foundation..... :............Magi I......... <br /> S 11 <br /> ------------- <br /> Ca aciv...__.. <br /> No. of compartments.__.... ••-.••.....Size_..� '�-• - p---••Liquid depth...� p tY• r <br /> Q0..:_.....Distan to nearest lot line_..r . ...... <br /> Disposal Field: Distance from nearest well-14A., Distance from foundation._ <br /> Number of lines...... <br /> of each . <br /> line_._.._...8�0 ,......Width f trench _!.............. <br /> Type of filter material ��- ..........Do th of filter material......j.S...`......Total 1 ngth._._�� -- ••• -V1 <br /> P � + <br /> Seepage Pit: Distance to nearest well.....................Distance from foundation....................Distan(a to e!lfes of line_...__..__.._.... O <br /> ❑ Number of pits...... - .... Lining material.. ........Size: Diameter............... ------Dept h...............----.--......... <br /> Cesspool: Distance from nearest well ..............Distance from foundation...._.__.........._.Lining aterial_.------------------------------------ <br /> Size: Diameter......................................Depth.............._^......... ........................Liquid Capacity= _.. mss' <br /> • ' ' t�m nearest b Iding.. <br /> Privy: , . _D.stende from nearest well_...... Q <br /> 0 Distance to nearest lot line------------------------------------------__...................................................................:........................ <br /> .... <br /> r' <br /> Remodeling and/or repairing (describe):........-•--..-----_- ---•-----•-----•.....---c....---••--•-•--......•--•---••--••...................•--• ._........ ... h.... <br /> ....................---................. - <br /> •--•-..._.__ <br /> ......................................---------- .......................................-----.._.....•----------- .........•............................................................................................ <br /> 1 here y ce y a _prepared=thron=g a r+o �wii�e�one-in^ecd ^�' ae1"JaaquirrCofy� <br /> ordinances, State laws, and D4es and regulations of the San Joaquin Local Health Qistrict. <br /> x' - _-= _ nem n /orTContractor� - <br /> _(5igned)..._ _:......................... .. ...... --•--- -- ------ , <br /> c _ ................•-----•--•-"--•"-"----------._.._......_.__.._.....{Title ._._.. <br /> - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed n reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE -- -•--•.-----•------------- <br /> APPLICATION ACCEPTED BY-- _ ....... ... . -----------•---•--•---•-- •".-- ----- _ Fe—�-� <br /> • a" DATE-----•-•---------------------••---------------------...... <br /> REVIEWEDBY...................--------------- -............._..,...... .................•-•......... <br /> BUILDING PERMIT ISSUED........... ---••- � <br /> ..----- .....r DATE---- .----------- •-----••------•-•-•-- - <br /> Alterations and or r ommendations:. *r'1 f•7..� ..._.._�►..!' -i..f -_[.'ts..---.......... <br /> - ... - <br /> . ..G....-- �°• - ' :........ ......................•-- _............. -:........._ ....................................-- <br /> wr ........................ --"------..--..-.._...._"....._............._... <br /> I AL INSPECTIONBYDate_......... ?-•!. Q •�"'r•• <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 S camore Sfreet 814 North "C"Street <br /> � 130 South American Street 300 West Oak Street yCelifornis <br /> Stockton, California Lodi, California Manteca, Celifoin11 Tracy, <br /> cs-a—zM iAsaw aiwoao �s-s. <br />