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APPLICATION FOR SANITATION PERMIT Permit.No. .....tivzlI? <br /> (Complete in Duplicate) Date Issued .--S/ V/ <br /> Applical-ion is hereby made to the Son 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 /> - --------- <br /> JOB ADDRESS AND 1-9q9-A)TI N <br /> .�. _:._. <br /> Owner's Name--------------- <br /> AXPA-S----------- --------------------------------- - Phone- <br /> Address--------------_------ <br /> .M C, <br /> ------------mz---------- - .--- <br /> Contractor's Name Z -_ ___ --------------__-----------------.- Phone------------------- <br /> Installation will serve: Residence Apartment House E] Commercial [I Trailer Court [] Motel E] other <br /> Number of living units: -------- Number of bedrooms -------- Number of baths4 <br /> Lot size -----7?)r' <br /> Water Supply: Public system [:] Community'system 1-1 '.Private �epfh to Wafer Table -------- ft. -------------------- <br /> Character of soil to a depth of 3 feet: Sand [i -1 <br /> Gravel F <br /> ra Sandy Loam El Clay Loam [g--C'—ay [:1 Adobe El Hardpan.[:] <br /> Previous Application Made: Yes E] No T�ew Construction: Yes [9-563 E] <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 well_____.._._------Distance from foundation___________________Material <br /> -61k4�_m� No. of compartments-----------------------------------_Size--- ---------------------------Liquid depth--------------------------Capacity--------------------- <br /> Disposal Field. Distance from nearest welt_.- 0- <br /> ---7 -.VDistance Distance=.from foundation ..Distance to nearest lot fine <br /> Number or lines___---------I-- <br /> Length oVeach line --Width of trench_________ <br /> .....-`-]-- <br /> ------- <br /> OT 7-- -- I ---- Depth <br /> 17- _t of filter material L.� ------ Total length----- -- --- --- ----- <br /> Type filfer material <br /> ------------ <br /> Seepage Pit: Distance to nearest well------------- --------Distance from foundation______-________.___Distance to nearest lot ne---- <br /> El Number of pits_---------- --------Lining material----------- -- ---:----Size: Diarn eter-----------------------Depth--------------------.............. <br /> Cesspool: Distance from nearest well_____ ---------Distance from foundation--_._.._____._...._ Lining material_...__--.___________.______:________ .A} <br /> ❑ <br /> aterial-------------------------- <br /> 171 Size: Diameter------------------------ - --------__Depth- ----------- ---------------- -------;---------------Liquid Capacity-. --------------I-----------gals. <br /> Privy: Distance from nearest well--- ---------------- ' _77 <br /> --------- - --- ---------Distance from nearest building------------------------------ <br /> ---------❑ -- <br /> Distance to nearesf lot line line-------------- 0 <br /> Remodeling and/or repa;r;ng (describe):-- ---------------------- ---------------------T"..::--------•------•---------------- <br /> -----------------------------------------------------------------------------------------------------------------------:----------------------- ­-------------- ------------------------------------------------------------ <br /> ------------------------------------------------------I------------------------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------------------V- <br /> ----------------------------------------------------------------------- <br /> ere y <br /> ---- <br /> ereby 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\)r<_...��. <br /> ------------------(Owner and/or Contractor) <br /> By:---------------------------------------------------------------•---------------------- ---------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can r be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> REVIEWEDBY -------------------------------------I------------- DATE------------ ----------- <br /> -------------------------------------------------------------- DATE------ ------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------- ------------- ----------------------------------------------------------- DATE---------------------- <br /> --------------------------------------- <br /> Alterations and/or recommendations:_._____________________________________.._._------------------------------------------------------------------ ------ ------------------------------------------------------------------------------I--------------------------------- <br /> -----------------------------I---------------------------------------:--- --- ------------------- --------------------------------------------------------------------------------------------- -------_------_ ----------- <br /> ­--------------------------------- -- ------------------------------- -----------I------------------------------------------------------ ------------------------------------------ ------------------I--------------- <br /> ---------------------------------- -------------------- ------------------------- ------------------------ ------------------------------------------------ ------------------------------------ <br /> FINAL INSPECTION BY:- - - 5------------------------------------- Date...... <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 /> ES-9-2M 145446 ATWCCD 12.54 <br />