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► <br /> APPLICATION FOR SANITATION PERMIT Permit No. .....7�_F.3... <br /> (Complete in Duplicate) Date Issued <br /> 0- 0-7 <br /> Applica4-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 mad .compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOC ------------------------------- <br /> Owner's Name__ ---- ---- ------ - --- ------ - ------------- ------------------------ - ------------------------------------------ - Phone------------------------------------ <br /> ::7 <br /> ;?!�..... .. .................... -------- -- -------------------------------------------------------------------------------------------------- <br /> Contractor's Name--------- --------------- ---------------------------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation <br /> hone----------------------------------- <br /> Installation will serve: Residence Apartment House [] Commercial F] Trailer Court 0 Motel [-] Other E) <br /> Number of living units: ___L Number of bedrooms _-Z. Number of baths _L Lot size ------ ------------------------------ <br /> Wafer Supply: PubIlic system X, Community system E] Private R Depth to Water Table .70ft. <br /> Character of soil to a depth of 3 feet: Sand E] Graver Sandy Loam jx Clay Loam [] Clay E] Adobe E]. Hardpan F1 <br /> Previous Application Made: Yes F] No X New Construction: Yes 0( No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank: Distance from neare'si'f well_.,_.4_6�Distance fror.11 founglation----- Material_____ __________________P9 No. of'compartments...... ,Z---------4---Size-- &---Liquid depth_.._____ 5 7----------Capacity_A40x?0____ - <br /> Disnosal Field: Distance from nearest well...>�O----DistaLnce from foundation___'__!. ___.-Distance to nearest lot lin;-----/o----- <br /> Number o' lines---------- --- Length of each line_*rl�< 1 0 <br /> 1 ------ --- Width of tre 7 _ __ <br /> --- ________________ <br /> Type of filter maferIaLS-1----��_ _X_Depth of filter material---------- -- ------Total length------- ----------------------- <br /> Seepage Pit: Distance to nearest well_____________________Distance from foundation-_--- -__ __Distance to nearest lot line._._--__________- <br /> El Number of pits----------- ------------Lining material-----------------_----.Size: Diamete'r'_._�-----------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well--- -------------Distance from foundation.,. ---------------1ining material,_-___________.___________________-. <br /> ❑ Size: <br /> aterial-------------------------------------- <br /> Size: Diameter------ -----------------------------Depth:---------------------------------------------------Liquid Capacity- ----- ------------------gals. <br /> Privy:' Distance from nearest well .,.-- ---------:------------------ -------------Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot lire------------------------------ ---------------------------------------------------------------------------------------------------------------- <br /> j <br /> ----------- <br /> Remodeling and/or repairing �(describe)------- -- -- ------ A4�1a F <br /> ...... ..e--- _-;,_ _._y__ ............... <br /> ----------------------------------------- ------------------- ------ <br /> --- --------- --------------------------------- <br /> ---------------- ---------------------- <br /> ---------------------------------- ........................ ......................... -------------- <br /> --------------------------------- - ---------------------------- ------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that fee work will be doln"e-in accordance with San Joaquin County <br /> ordinances, State 1s, an 4 rules and regulations of the San Joaquin Local Health District. <br /> (Signed).:----------------------------------- -------------------------------------- ----------------------------------------------------------- -----------(Owner and/or Contractor) <br /> By:----------------- -----(Title)------------------------------------------------ --------------- <br /> (Plot plan, showing size of lo+, 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------------------------------- -7---------------------- <br /> REVIEWED BY------------------- ------------------------- ----------------------- - ---------------------- <br /> ----------------------- DATE_------- --------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------- ---------- --------- DATE_------------------------------------------------------------ <br /> Alterations and/or recommendations------------------------------ -I---------------------------------------------------------- ----------------------------------7-------------------------------- <br /> ---------------------------------------------------------------------- ---------------------- ----------- ------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------------------------------------------I------------­-------------- ------------------I--------­------------I------------------------------------------ <br /> -------------------------------------------------------------------------------------I----------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------- .......... -------- --- -------------I-------------------------------------------------------------------------------------------------------------- <br /> r - � � <br /> FINAL INSPECTION BY------------ -----------------------------------­4------- Dafe_.------------------------------------------------------------•--------------- <br /> SAN JOAQUIN LOCAL"LHEALTH 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 14544e ATWOOD 12.54 <br />