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APPLICATION FOR SANITATION PERMIT Permit No. ..... 3-a-. ..... <br /> (Complete in Duplicate) <br /> Date Issued -----*yC--- <br /> Applica*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 /> j L ��. <br /> !g 1,r-a44 r KJ 67 W A,.L .l r <br /> JOB ADDRESS AND LOCATION-- . - <br /> Owner's Name---'C I�r �7- �C ��.: /7�. �. � K . Phone.//V:_6 j/_-7-7-- <br /> Address------------- S:/ -------------------------------- <br /> ----------------------------------------------------------------------------------- <br /> Contractor's Name-----------------__-- ----- -- -- N ` <br /> 67 <br /> ��� ------------------------ Phon�®` ----��-� 7 <br /> Installation will serve: Resi encs ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other A4,9501`uM. <br /> Number of living units: -------- Number of bedrooms -------- of baths -------- Lot size -_----------------'---..------_-:-_- <br /> _ - ------------------- <br /> 1 Water Supply: Public"systerri N Community system[] Frivate ❑ Depth to Water Table� ft. y <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 X New Construction: Yes No ❑ A <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if,public sewer is available within 200 feet.) w <br /> Septic Tank: Distance from nearest weII49_ZC.7.A_A_Xisfance from foundation_f_.YF__._.---.Material _-- <br /> No. of compartments.- ---_ _.-. „ <br /> t F `Dk_tLi id depth- Q-------- ------Capacity:--/, f�U` <br /> Disposal Field: Distance:from nearest well_`-_-----.--._-Distance from foundafion-!-----------------Distance to nearest lot line---.--------_-__- <br /> . � <br /> ❑ Number of lines---------------- ------------------Length of each .line Width of trench------------- i <br /> Type of filter material-------------------------Depth of filter material----------.• ----_-----Total length----.----------..------------------------- . <br /> Seepage Pit: Distance.fo nearest well-.%I' ut. Disfance from fo dation--2.Q-..--.__.Distar9ce to nearest lot <br /> 14 Number of pits.--- Lining material-- .._--- Size: Diameter._, -.-.-.-.--_-De th_ ` ! <br /> p <br /> Cesspool: Distance",from nearest well-----------------Distance from foundation__------------------Lining material_____-____-:__.-.-----_------__-----. <br /> ❑ Size: Diameter-------f------------------------ ----Depth--.----------- ------------•------ <br /> - - - ------Liquid Capacity------------------------=---gals. <br /> Privy: Distance�rlrom nearest well___________--------------------- ---------- from nearest building _ Y <br /> --------------------- <br /> " Distance'to nearest lot line. -- - - - ---- -------------------- --------------------------------------- <br /> Remodeling and/or repairing (describe): - - ---- r k ------•---- -------------- <br /> -••------•-- ......•--------------- <br /> �,� <br /> = "� <br /> A ! ' `4lLrl - - <br /> --------------•--------------- ----- ---------------•----------------•-------•------ ------•---•---- ----- ---------------------------+----------- ---------•r-t <br /> I hereby ce4fThatared this application and that the work will be done.in accordance-with San Joaquin County <br /> ordinances, States an regulations the San " uiin LLocal Health Disfrict",*,(Signed)--.._...---- - . ; =' -_ wrier and/or Contractor <br /> By:------------------- . �� T 1 +(Title............!I ,-. <br /> (Plot plan, showing size of , location of system in relation to wells, buildings,'etc., can beplaced reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------ ----- ---------- --------------. DATE-. <br /> --------------------------------------------------- <br /> REVIEWED BY----------------------------- =t DATE-�-------------•---------- <br /> ------- <br /> BUILDING PERMIT ISSUED--------- ------------------------•---------------------------•---------- - "------------ .- DATE--- '-. <br /> Alterations and/or recommendations------------------------- I <br /> ------- ------------------------------------------------------- ------- <br /> --------------- ---- ------- --------------------- --------------------------------------------------­-------------------- ---------- <br /> FINAL <br /> ------------ -- -- - <br /> FINAL INSPECTION BY--- -- --------- Date-'-)-. -------------------------- <br /> INN SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Amer+cen`Street a, 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California '"�Ji,,.Celifornia Manteca, California Tracy, California <br /> YM1 -. <br /> ES-9' 145446 A7W04f <br /> N <br />