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APPLICATION FOR SANITATION PERMIT Permit No. ....... <br /> (Complete in Duplicate) Date Issued ----I---1_0_ <br /> gA <br /> plica-1-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549 <br /> 6 //1 <br /> JOB ADDRESS AN CATI ..... . <br /> Owner's Name_-- ----- ------------ e .611& <br /> -- ------------ - ---- ---------- -- ------- --------------- <br /> Address......---------- to.K---- ---4- V_ <br /> - - -- ---------- ----- <br /> Contractor's <br /> ---*------- -------- <br /> hone- -_. ___ __0_ <br /> Contractor's Name-----•- -- --- ----- ---- --------------0,2'fl---Z!14------------------------------------------- ----------- P -4 7 <br /> Installation will serve: Residence Apartment House 0 Commercial E] Trailer Court L]I Motel L] Other E] <br /> Number of living units: j---- Number of bedrooms _._/__. Number of baths __j_._ Lot size ---/19--AME-7----------------------------- <br /> Water Supply, Public system El Community system [] Private Depth to Water Table -5V_ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [-] Clay Loam 0 Clay 11 Adobe El Hardpan El <br /> Previous Application Made: Yes E] No Z_ New Construction: Yes E] Nor <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 /> %ai019 No. of compartments---------- -- ------------Size-------------------------- -----Liquid depth_--------- ---- - --------Capacity----------------------- <br /> Disposal Field- Distance from nearest well_________________Distance from foundation------------------- Distance to nearest lot line________.___..... <br /> �a1 <br /> ine-------------_- <br /> at 517W49 Number ol lines-----------------------------------Length of each line------------------___--- <br /> ---_Width of trench----------------------------------- � <br /> Type <br /> rench----------------------------------- <br /> Type of filter material-__---------------______--------------------Depth of filter material____..__._..__.__jr----Total length_____________--____.._--________________`V T_ <br /> Seepage Pit: Distance to nearest well-.;-100---------Distance from 4o)Inclation-_,7--------Distance to nearest lot Iine_lu------ <br /> it----------- -07 'Number 54 Number of pits----07*tk--------Uning maferial--AS.444C.&_Size: Diameter-.33'_ Depth-- --------------------- <br /> Cesspool- Distance from nearest well--------------_Distarce from foundation--------------------Lining material__.__.-_-_-_---------.-_______.______ 0 <br /> F1 Size: Diameter-------------------------------------Depth------------------------------- ---------- - -----Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------- ---------Distance from nearest building._____.___.._._._______________--____.._. <br /> ❑ <br /> uilding------------------------------------------ <br /> F1Distance to nearest lot line------- --------------------------------------------------------------- ---------------------------------------------------------------------- <br /> a Z� <br /> Remodeling and/or repairing (describe):------ ---- --?_ ----A------------ --------------- --------------------------------------------------------------------------- <br /> ��i --- ___ ----------;---------------------------- <br /> ------------------------------------------------------------------------ ------------- 2------------------- -- ----- <br /> ----------------------------------I--------I-------------------------- ---------------------------------------------------------------- ---------------------$0--------------------- ------------------------------- <br /> -------------------------------------------------------------------------------------------------------------I-------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I havR-preps'qd this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and r,4111 sand gulations of f San Joaquin Local Health District. <br /> (Signed)-------------------------- -- ------ ------ ---------------------- ---- ---------- --- (Owner and/or Contractor) <br /> By:.....------------------------- -------- - ---1 -- --------------- <br /> Title ---------- ---------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pla2__ Anreverse side). <br /> FOR DEPARTMENT USE ONLY <br /> r_'N <br /> APPLICATION ACCEPTED BYt_ <br /> I .............................__-------- ---------------------------------------------------- DATE?'=--- -------------- --------------------------------- <br /> REVIEWEDBY------------------ ---------- ----------------------- ------------------------------------------------------ RATE_ -------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------- -------- ------------- DATE------ --------------------- ----------------......... <br /> Alterations and/or recomm!rVdations------ - ------- ---------- --—-- ----- ---------------------------------------------------------------------------------------------------------------- <br /> -------------------------- ---- ----------------------------------------------------------------------- ------ <br /> ----------- --------------------------------------------------- --------- ---- -------------------------------------- --------------------------------------- <br /> ------------------------- ------------------------------------------------------------ ------ --------------------------------- -------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------­------------------------------------------------------------------------ ----------------------------------------- ------------ -------- <br /> FINAL INSPECTION BY:. <br /> -------- - ­­------------------ ---------------------- Date...._ <br /> -- ------------ ---------------------- <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 -G446 ATWCOD 12-5, <br />