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1 <br /> I� <br /> APPLICATION FOR SANITATION PERMIT Permit No. _1 aA <br /> I (Complete in Duplicate) Date Issued 11/71..5.x,,., <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. <br /> This application is made compliance w' h County Ordinance No, 549. 2 k_O(Pp� Zy <br /> -4T61 <br /> JOB ADD.ESS AND ATN ...... ............ ... .. .....1�"'�"�`^`" <br /> .. <br /> r's N me. Phone................................ <br /> Address.-- .. ••= -- <br /> .. <br /> Contractor! Name.............. ..................................................._._........... ......................................................... Phone................................... � <br /> Installation ill serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑/ otel El ' Other 0 <br /> i <br /> Nu er of living units: -----_. Number of bedrooms -__Number of baths ._,I... Lot size ._ . .14' -�•-_-_--.---_-----_- <br /> I t <br /> Water Supply: Public system [j Community system ❑ Private [Depth to Water Table ft_ <br /> Character if soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction; Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> (Nosepfic tank or cesspool permitted if public sewer is available within 200 feet.) ,. <br /> Septic Tank•: Distance from nearest well-1.6.0t Distance/V.o _'.X_S_Liquid <br /> •oundat' �0.............MaMate <br /> ._aZ. ....._......._.._..___961 ­..Capa . 6.1_..._.__.�No. of com artmens_..---• ---- Size.._ " de th..._._. . <br /> Disposal Fil Id: Distance from nearest well.. 017.Distance from foundation_../.D.-_.._-_.Distance to nearest lot line <br /> Number of lines.......... �....._Length'of each line..____.C _. Width of trench.....7-- ................ <br /> Type of filter material..... ath of filter material.......__�ff------Total length-......1AO...................... <br /> Seepage Pi : Distance to nearest well......................Distance from foundation....................Distance to nearest lot line..........•....... <br /> 0 Number of pits................------Lining material........................Size: Diameter.......................Dept h----............................. Q <br /> Cesspool: Distance from nearest well.................Distance from foundation............_.......Lining material._ R� <br /> _ Size. Diameter............ ........................De th_.____.____._......_____- ..........__.._.__...-_,Liquid Capacity als. <br /> Privy: Distance from nearest well.................................................Distance from nearest building.................................. <br /> ❑ Distance to nearest lot line.............................................. --•--•----...-------•----•--•__---•-- -------•------•---•--•-- .� <br /> Remodelin and/or repairing (describe):.......... ...................... ........................................................ ---------.-------...---------...-..........--- <br /> -•------- .................................................... ) <br /> -----•-- ........... <br /> • - - - <br /> ...............................-..__..........----•---•------------------••-•--•-•-------•-------------------•...----•---------------------..............------•--.....:_.....------........---•-•---•--------•--- ------ <br /> I <br /> -•l heredy certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,Vtfa ws, nd rule nd gulatons�of fh an Joaquin Loeal Health District. <br /> ! �(Signed)_...-- ......._... ------ -----------•---•-- ....--•---...........................................------ ----(Owner and/or Contractor) <br /> By:J ....... <br /> .................-................. ----•-••-•..-•--------------------...------(Title)-----_.---•--------------•..-. .._--..-------------•--------- <br /> (Plot plan,isj owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATI N ACCEPTED BY _.. ........... _........ DATE....................... ....•--..._ <br /> _ �- -� <br /> REVIEWED BY....................... ;............_. ._... .._._.. DATE....._._.__... . • • . _._..._..... <br /> BUILDING ERMIT ISSUED.. ._...... ~/ ............-E . -•--•---• ....... DATE......................_... ............................. <br /> Alterations nd/or recommendations•_.-.-..................................................... <br /> . <br /> . ....•---•---...._........_..--------•............................................................... <br /> .................. <br /> --•--------•--•-----------------•-•------•----------- <br /> ....... <br /> ........................................................ <br /> ------------------------------------------------ <br /> .... <br /> .....................•----•-----•-•-•---.._._------.........__.........................--•--................_...._........._.._...........•---...-----.........--•--...............__....-•----............--•••-•••-•-.--_... <br /> ................... ............................... ---•----.------ -..._...............---•-----............••--•--•----•-._....--•--------..._......................_......_....•-•-•----......-•-.---._............ <br /> IIS <br /> . <br /> FINAL ASPECTION BY:..__... Date.................. ............................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Sou+ American Street 300 West Oak Street 132 Sycamore Street 814 Nor+h "C" Street <br /> S+ock+on, California Lodi, Caufornia Manteca, California Tracy, California <br /> iI <br /> E8--5145446 ATWGCO <br />