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APPLICATION FOR SANITATION PERMIT Permit No. Z" <br /> (Completein Duplicate) Date Issued <br /> ___._��-/�-S- <br /> ,,-Oplica4-ion is hereby made to the San Joaquin Local Health District for a permit To f f ictaF#d <br /> cruw stall the work herein described. <br /> jis application is made in compliance with County Ordinance No. 549, OU4,f c., <br /> JOB ADDRESS A.NDLOCATION. ..... ------a-Q- <br /> Owner's Name------ ----- ------------------------------------------------- - ------ --------------------------- Phone__44,6----_---- <br /> - g <br /> Address----------------- ----- "o—-------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name_--- —------------------------------------------------------------- ------- Phone_,A:54_3-3�_�:4_ <br /> Installation will serve: Residence VApartment House F]ft Commercial E] Trailer Court 0 0, E]el Other El <br /> 1 ( 21 1 <br /> Number of living units: _.I--- Number of bedrooms Number of baths _--J___ Lot size a------- ------ <br /> ----------- --- --------------------------- <br /> Water Supply. Public system E] Community system [I :Private OR/Depth to Water Table <.o- ft. <br /> Character of soil to a depth of 3 feet: Sand C] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe EV Hardpan ❑ <br /> Previous Application Made: Yes E] No V Now Construction: Yes NKN, 0 <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 /> No. of compartments____--------- - -_...Size---------- ---------------------Liquid depth----------------------- -Capacity----------------------- <br /> Disposal <br /> Capacity----------------------- <br /> Disposal Fie d- Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line-_-.-__-__-----_- ``� <br /> Number <br /> ine----------------- <br /> Number of lines--------------------------....__._Length of each line-------------------------- ­rWidth of trench.---------------------------------- <br /> Type <br /> rench------------------- --------------- <br /> Type of filter maferial__- ---- - - ------.-.-Depth of filter material---_______-______--_Total Total length---------------------------- <br /> . <br /> Seepage Pit- Distance to nearest well____1_dL0. ......Distance from foundation____ --------Distgnce to nearest lot li <br /> ................. <br /> Number of pits----I----------------Lining material_ •L----- ----Size: Diameter_,S0.............Depth_--_7--%--------------------- <br /> Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material_-_____------------_._-______-------_. <br /> e',, <br /> aterial-- ----------------------------------- <br /> e-,, El Size: Diameter-------------- ----------------------Zepth----------------------------------------------------Liquid Capacity---------------------------gals. <br /> rivy: Distance from nearest well------ ------------ --------------- ---------Distance from nearest building------------------------------------------ <br /> F1 Distance to nearest lot line ------ - - - ---- - ------ - ----- --------------- ----------------------------------------------------------------------------- <br /> Remodetinq,ancl�or rep a iri k�j.I describe):---- ------L,�---- ---------------------- <br /> .......O.A.A .4 J <br /> ---------------------------- ---------------------V- -------------------------------------------------------------------------------------------------- <br /> ----------------------------------------- --- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------I----------- ------------------------------------------------------------------------------------------------------------------------------------------------------- <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 /> ------.-.--(Owner and/or <br /> (Signed)- ----- ---- -------- ------------ --------------------------------------------------------------------------- ------------------- Contractor) <br /> Ely:----C�.............. ...... .......t_j A------------- -------- ------ <br /> 11 _.W&k,6 ,,-------------------------------------------------- ......P 0-4 <br /> (Plot plan, showing size of I location of system in relation to wells, buildings, etc., can be placed on rev&e side <br /> 16 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- E - -'- ------------- ---------------------------------------- DATE--------- <br /> j -3---------------- <br /> REVIEWEDBY--------------------------------------- - -- -- -- --- ------- --------------- -------- ------------- ---------- DATE-------------------------- <br /> BUILDING PERMIT ISSUED--------------------------- - -------------- ---------- D TE--------------- Z <br /> Alterations and/or recommendations:-_-____ - - --------------- <br /> K I'- -.;I - ____------------ <br /> _././.-"- ------5 ---�_.I---0 < ---------------------- ---------- --------- - ------- --------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------- ----------------- ----------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------ ---------------------------------------------------------------------------------------------- --------- ------------------------------------- ------------------------ ...... <br /> ------------------------------------ I----------------------------------------­.. ........... ------------------------------------------------------------------------------------------------------------------------------ <br /> �[NAL INSPECTION BY:-17/ ,�.�/ --------------------- Date---- --------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stoebon, California Lodi, California Manteca, California Tracy, California <br /> ES-9-21A 145446 ATWCOD 12-54 <br />