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APPLICATION FOR SANITATION PERMIT Permit No. ..t_qf_77----- <br /> (Complete in Duplicate) Date Issued /-060A.. <br /> Applical-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 /> JOB ADDRESS AND -------- --- --- ------- --- --- <br /> 6. OCTION.... ------ <br /> ----------------- Phone--------- ----------------------- <br /> Owner's Name------------------ -------9--- -------------------------------- -- ------------------------ <br /> 4aj , 7 <br /> Address........fU-.1 .. - ­ ---- <br /> - ------ ------ ------- <br /> ------ -------- .............---------------- - -- ----------- <br /> ------ -- ---�-;---- ------ - --------------- <br /> one-- <br /> Contractor's Name----- ------- - - -- - -------- --------------- <br /> Installation will serve: Residence W Apartment House ❑ Commercial [-] Trailer Court ❑ Motel [3 Other E] <br /> Number of living units: ---V Number of bedrooms _3--- Number of baths Z-- Lot size ------ ............... <br /> Water Supply: Public system El Community system El Private X Depth to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 foot: Sand Ej Gravel E] Sandy Loam [A Clay Loam E] Clay F] Adobe E] Hardpan Ej <br /> Previous Application Made: Yes F1 No K New Construction: Yes [Z No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest welLJ7M._'*------Distance from foundation--.-1-0----------Material----- ------_..---- <br /> No. t ". <br /> of compartments-------- -------------Size-.5-'- 1---------- ----Liquid clepth.__N57----- - --------Capacity -4)-- -- ------ <br /> LKI <br /> Disposal Field: Distance from nearest weli_ _Distance from foundation----�v----------Distance to nearest lot line-.,A <br /> Number of lines-- ---- Length of each line-__---. ----------.-.Width of tr.ench-----119--- ------------- <br /> T <br /> ---- -- <br /> a material- Depth of filter material- ----------------- <br /> Type of filter m -1-t-. r,.t?d, _�e p -----Total length <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------. Distance to nearest lot line----------------- <br /> F1 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----------------------------­. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-..-.--..-----.---.Lining material--..--..----___-----------_----_----_. , / <br /> Size: <br /> aterial--.----------------------------------- <br /> Size; Diameter----- ------ -----__---------------Dept h----------------------------- -------- -------------Liquid Capacity------------------------_--gals. <br /> Distance from nearest well-----------------------------------------------------Distance from nearest�'5uilding------------------------------------------- <br /> El Distance to nearest lot line ---------------------------------------------------------------------------------------------------------------------------- - <br /> Remodelingand/or repairing (describe):-------- --------------------•----------..-----....I.......I------------------------------------------------------------------------------------------------------------------------I----------I------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------- --------------------­I---------­ Joa-•--m--- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ------- -- -------- __6 c '0 <br /> (Signed)---- ----- - -- --------- -- -------- - -- ----- -- --------------•-•------ ----------------------------- rwn7rvnd/or Contractor) <br /> ---- ---------- --- ------ -------------- -------------------- <br /> ---------------- <br /> By: ...... - ---- ---------- --- ------ -------------------- (Title)---- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 49 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- --------------------- .......1-------- ------- -------------------- ------------------ DATE... -------------------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------ --------- DATE-------------------------I---------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE..------------------- ---------------------------------- <br /> Alterations <br /> ------------------------------_Alterations and/or recommendations:--- ..........___-- ------- --- - -------------------------------------------------------------------------------*------------------------------- <br /> -------------------- ---------------------------------------------- -----------------------I-------------------------------------------------------------------- ---------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------- -----------_ ----------------------------------------------------------------------------....--1---------------- <br /> -----­------------- --------------------------------------- ------------------------------------------------------------------------------------------ -- ---w---------------------I---------------------------------------- <br /> ------------------------------------- ----------- ------- -------------I-------- --- ------------------------------------------------------------------------------------------------------------------- -------------------- <br /> FINAL INSPECTION BY:-.1 - Date-.--/..7 O-4y--------------------------�, ��---- - <br /> SAN ------------------------ <br /> 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^Twona <br />