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- ` _'APPLICATION FOR SANITATION PERMIT Permit No. <br /> d� (Complete in Duplicate) Date Issued y2_ <br /> g 3 — Io 1 <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct an insfa!the work herein described. <br /> This application is made in compliance-with County Ordinance No. 549., - <br /> -0- <br /> 14, <br /> 49., <br /> '3 Z 14,4-7-1,06.� `��' <br /> -- <br /> JOB ADDRESS AND LOCP,TION = D --------------------------------------`----- ------_--------------------- <br /> q t <br /> , <br /> '' +LiG- N��. - � �"'�-----" - Phone. c r� <br /> -------- <br /> Owners ame_,_ .- - -•-•--------••� - - ---- ---------�- -- - � <br /> Address------------------ ` �"` '� t G► --- --.--------------------- ------------­---------- ----- -------------------------------------------••- <br /> Contractor's Name__ ------------------------------ ----=--- -------- -`----- Phone----------------------------------- <br /> ------- <br /> r•.�r. f. ,,, -;,p <br /> , ...r . - <br /> Instal�ation will serve: ?Residence.❑ Apartment House ❑ Commercial Trailer Court ❑ Mo#el ❑ O#her <br /> Number of living>units: :- -_- Number of bedrooms ----__- Number f baths ---_--- Lot size --- ----�"�------- ----------------- <br /> Water Supply: Public system F1 Community system F] Private Depth to,Water Table -------- ft. <br /> Character of soil to a depfh.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam /Clay Loam ❑ Clay ❑ Adobe ❑ . Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public $ewer is available within 200 feet.) t <br /> Septic.�Tank: 1 Distance from nearest well_.:S` -----Distan from foundat �` - Material- --------------- -- -_---- <br /> 1 No. of compartments-----.- - -.- -Size-.--:-•- JA_ ��- L. uid de �h__-___---- -------.-Capacity <br /> - „o <br /> •.,,nn �� <br /> Disposal' Field: Distance from nearest well-.- +-- ---Distance from foundatia -. ��--:__---, istance to nearest lot lin1�_-------- Uv <br /> Number of lines----------.. �. ------------Length of each line° ---_c _- - Width of trench-------- - ----f.----___-_-- J <br /> Type of Vfer material- -.r_4hA., XDepfh of filter material-------_g. -_-_--Total length------------L&Q-11------------- <br /> Seepage Pit: Distance to nearest well----- ---------------Distance from,foundation-------------------.Distance to nearest lot line----------------_ <br /> ❑ s Number of pifs- --------------------Lining material-------------------'.---Size: Diameter------------.----------Depth_------------------------------- <br /> Cesspool: r Distance from nearest well-----------------Distance from foundation---------------- Lining material---------.--------------------------- ,y <br /> Sizer Diameter- - <br /> ----------------___-- ------Depth---------------------------------------------------Liquid Capacity--------------------- gals, C <br /> Priv distance from nearestwell---------------------------_------------------ .-Distance from nearest building-------------------------------------- <br /> -- <br /> 1 <br /> ❑ Distance'to nearest lot line-------- ------------------- ------- --------...--------------------------------------------------•---------- ------------------- <br /> 1 <br /> Remodelingand/or repairing'(describe):------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- <br /> -- � <br /> ------------ <br /> - <br /> --------------------•------------- -------------------------------------------- -------------- <br /> --- --------------------­---------------------------------------------------------------------------- <br /> --------------- -----•-•--------------•-------------------=------------------------------------- --------------------•--------------•--------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfl <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> r <br /> ' `' '�' Y `''r------- -- -------------- -(Owner and/or Contractor <br /> A/(Signed]-_- �. <br /> ,'._.."_.._ __. - Title <br /> sr-------------------------------•--------------------------_-- ---- -- - - ( ] <br /> (Plot plan, showing size of Int, 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_ -------------------------------•------------------"---- <br /> REVIEWEDBY------------- - DATE---- - ---- -------------------------------------•-•---- <br /> • ---�--�----�- <br /> --------------------- <br /> BUILDING PERMIT ISSUED-------------�------------- ----------------------------------------- ------------- <br /> ------------ DATE-------�'------- <br /> Alterations and/or recommendations------------------------ ------------------------•---------- ----------------------------------------------------------------------------•------------ <br /> -----------------------------••----------------•-- <br /> FINAL INSPECTION BY:.... -------------- .......... Date---- -( -. . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Horth '•C' Street ' <br /> Stoekton, California Lodi, California Manteca, California Tracy, California <br /> E5-9 145446 PTWOOD <br />