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V . <br /> �y APPLICATION FOR SANITATION PERMIT Permit No.rr <br /> (Complete in Duplicate) <br /> .> <br /> Dafe'!ss <br /> '~A pplicakion-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 LOCATION.--_.---- --------- ______C�_ <br /> Owner's Name ------- - ------• - ------- Phone <br /> ,. Address_.__: .� _ <br /> -----•------------- ---­-----------------------­-------------------------------------- <br /> Contractor s <br /> ---------------- -- <br /> Contractor's Name-----_-------........ - ------- •__... ------------------------ ------------------------------•-----------•- •------- ------- Phone, . 7 a <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ <br /> Number of living units: _/__ Number of bedrooms ___c Number of baths ___/_ Lot size .___� X_/_-L2�_____________________ <br /> Water Supply: Public system '❑ Community system ❑ Private [Depth to Water Table$7� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2-_'H�ardpan ❑ <br /> Previous Application Made: Yes ❑ 4 No ®�— New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> apk: Distance from nearest well_________________Distance from•foundation_________-_________Material_________--____-__-________________---_________- <br /> No. of compartments--------------------------Size--------------------------------Liquid depth.-------------------------Capacity----------------------- <br /> q,ti <br /> spos I field: Distance from nearest well ................Distance from foundation--------------------Distance to nearest lot line________-___--__- <br /> ' Number of lines.-,--------------------- ------Length of each line------------------------------Width of trench---------,-------------------_----- <br /> Type of filter material-------------------------Depth "om <br /> ial_-------------,--------Total length---------------------------_----•---_----- r� <br /> Seepage Pit: Distance to nearest well_.__._____________Dista encla ion___. _4________.Distance to nearest lot line__ _--________Number of its----------------------Linin mate a1-- cZ'�------------- <br /> P g e: Diameter__ �� Depth A <br /> 4 ; <br /> Cesspool: Distance from nearest well________________Dista oundation-____-_-__.--___-._ Lining material--------------.----------------------- <br /> El Size: Diameter- a ----------Depth----------- ----------------- ----------------------Liquid Capacity----------------•- gals. <br /> Privy: Distance from nearest well__________--------------------------------------Distance from nearest building.__-______.__.___________________.___-.... <br /> ❑ Distance to nearest lot line---------------------------------------------- ------•------•-------•-------------• -•-----------------------•----------------- <br /> Remodeling and/or repairing (describe)--- -------------------- ------------ -------•-•---•-------------------------•------------•-----•-------•-------- <br /> ...............................................................i---•----•-••----•-•----------------------------------••---•----.-_-----------------------•--- ---------------------------•-------------•----------------------- <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, Stat aw�les antions of the San Joaquin Local Health District. <br /> Siried /i_.__ Owner and/or( 9 ----..------•------•------------------------------- ---- --•------------- ----------------------- -------------------------- / Contractor <br /> By:_-------------------------•---------------------- �� �' �� �`� (Title) a. <br /> plan, showing size of lot, location of system in relation to well , buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY I <br /> 1 <br /> APPLICATION ACCEPTED BY----------------- -----------7;,��Z <br /> S�__ __-------------------------- ----------------------- DATE-------- -------------------------------- <br /> REVIEWED BY-------------------------------------- ------------ - DATE--------- --- `- <br /> BUILDING PERMIT ISSUED--------------------------------- -------- - ------------------------- DATE---------------Alterations and/or recommendations:..... _-__ <br /> \7Z1 <br /> _ <br /> ---•-------------- <br /> ---------------- �---- ��'_. a._ .� --------- ---------------.---_-----------------------.--------------------------------•- -- ••---- <br /> ---- ------- -------- ------------------ ------------ <br /> -- ---------------------------- -I------------- ------------------------- ------------------------------------------------------------------------------------- <br /> ------------------------------------------- ---------------------------- --------------------------------------------------------------------------------------------------------------------•--------------- ---------­ <br /> FINALFINAL ! <br /> NSPECTlON BY:--- .--`--------- --- ---• ---- ---- - Date---�:'^--�---�---y`�--�------------------------- <br /> ••-------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Ameriean Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California I Lodi, California Manteca, California Tracy, California <br /> Es-9 1x5446 ATWODO , <br /> I <br />