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APPLICATION FOR SANITATION PERMIT Permit No. ... .3- -4 <br /> (Complete in Duplicate) I <br /> Date Issued --------►.��.�.�-. <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 /> JOB ADDRESS AN OCATION _ 7 --v!/-`sem '' ----------------------------------------------------------------- <br /> Owner's Name-------- ----------- n L.L -/4�4------ - ------------- <br /> --- - --------------------- ----- ---------- -. Phone.- ------------ <br /> Address............ ... -- ..........------ <br /> ---------------- <br /> Contractor's Name ---------------------------------------------- ------------ Phone <br /> Installation will serve: Residence [2-. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J------ Number of bedrooms ._ Number of baths _�----- Lot size -.-/a.....K__1, <br /> Water Supply: Public system Community system ❑ Private R11 Depth to Water Table _w/o ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay D Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No �j New Construction: Yes Ea No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: r ' tante from nearest well-----------------Distance from foundation--------------..__-.Material------------------------------------------------ <br /> compartments-------------------- <br /> _.------.__-_.-_----.--------_.-._-------.---compartments-------------------- -----Size------•-- ---------------------Liquid depth--------------------------Capacity <br /> DisposalpField: DKISnce from nearest well-----------------Distance from foundation------------.-......Distance to nearest lot line----------------- <br /> ❑G r of lines-------------------------- Length of each line--- ------- -----------------.Width of trench--- <br /> jgptof filter material-__--------------------Depth of filter material--------------.--I---Total length---._--.----_-----.-----------..._--__--.- ff'' <br /> ,9� wlO --.--- Distance nearest I <br /> Seepage Pit: Distance to nearest well from foundation_- <br /> �_ Number of pits.... material, '4lxDiameter__. ...-__Deptn.�__ _----- ----_ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- lining material---------__._-_.----._.-.------------. <br /> ❑ Size: Diameter------------ ------------------------Death--------------------- ------ ----------------------Liquid Capacity------------------ -------gals. <br /> Privy: Distance from nearest well----------------_----- ---------------------Distance from nearest building__-.-...-------------__-----_- <br /> ❑ Distance to nearest lot line- ------- <br /> Remodeling <br /> -----Remodeling and/or repairing (describe)---------------------------------------- ------------------------------•--------•--------...--•--•-------•---•------.._..---------•-------- 1 t <br /> -----------------------------------------------------------------------------------------••------------------------------...-•------------•----r------------------------- ------•-----•--------- <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 /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----- ,-- ----- ----------------- <br /> 9 ) = (0 er and/or Contractor) <br /> Byv'/ ---------- ------------------------(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---- ----- ------------------ ----------------------------•--• ------------------- DATE---- <br /> REVIEWEDBY----------------------------------------------------------- - --- ---------------------------------------------------------- DATE--------------- <br /> BUILDING PERMIT ISSUED----------------------------------- --- - --- ----------------------------------------------------- DATE------\-_. <br /> .� <br /> Alterations and/or recommendations:------- ---------- ----------------------------------- <br /> ------------- <br /> 4--Z------:D�-_e---- --- ---- - ---------------------------------1—----------------------------4-------­-------------­- <br /> ---------------- --------------------------------------------------------- --------------- --------------------------------------------- -------------------------------------- - ------------•---------_------- <br /> --- --- ----- -- <br /> - - - --- -- ------------------------------------------- <br /> FINAL INSPECTION BY:- .. ............................ Date f .,-----)....y--- ---(-------------- - <br /> SAN 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 /> E5-9 145446 ATWOOO <br />