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�x APPLICATION FOR SANITATION PERMIT Permit No. .....7--,Z___.__l/_ <br /> (Complete in Duplicate) / <br /> „ Date Issued _______ <br /> Applica+ion is hereby matte 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...__. Ib . Qom_--M9de. to_s_._atockton----------- ----- - --- ------------------------- <br /> Owner's Name------ 0UiB..-'g0-x'3:s -------------------------------------------------------------------- ---------------------- Phone.---, --------------------------•--- <br /> Address-------------a.amle----------.................------------------...-----------._------------------------=----------------------......•--•---------------------------------------------------------------- <br /> : nk Service <br /> Contractor's Name------- O...&... t--.SP ]C TB = ----------------------------------------- ----------------- Phone----------------------------------- <br /> Installation will serve: Residence K] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _l____ Number of bedrooms ----2- Number of baths -1--- Lot size .___-0---7C...IZQ_---------.----------------------- <br /> Water Supply: Public system J] Community system [I Private ❑ Depth to Water:Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [X New Construction: Yes KI No ❑ <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 /> MUTING No. of compartments------------- ---- - ----Size--------------------------------Liquid depth--------------------------Capacity------ ---------------- <br /> DisposalF�I`d: Distance from nearest well-----------_____-Distance from foundation--------------------Distance to nearest lot line.__..____._._._._ <br /> J Number of lines------------------------------------Length of each line...... ...------.-"-.....Width of trench----------------------------------- f <br /> Type of filter material-__----------------------Depth of filter material _______.____..__,-----Total length____________________-_____________________ II <br /> i <br /> Seepage Pit: Distance to nearest well_.__n4ne...-__Distance from foundation------1Q_'......Distance to nearest lot line------5__-____. <br /> _.____Linin material___-br-tok__._Size: Diameter__-__ .f.._..._..Depth__-__ 5 <br /> �] Number of pits._::�-_�--- g �- � ----------------••-- <br /> Cesspool: Distance from nearest we]L________________Distance from foundation___-_____._______.Lining material--------------------------- <br /> ❑ Size: Diameter.--- f-----------------=-- --- -- --- Depth--------------------- --------- - -- -------------Liquid Capacity----------•----------------gals. <br /> Privy: Distance from nearest well..........................____._._..-.___.---_Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line---- ------------------------- -------------------------------------------------------------------------------------------------------------- <br /> Remodelingant{/or repairing {describe}=-------- ----------------•------- -- ----------------------•---------••-------•-----------•--------.-_--------------------•------- <br /> ______________________________________________________________i..__________________..-______.--..._- _.._._________...._______________________.___.________.__. <br /> --------------------------------------------------------------- <br /> i <br /> • -1 ---- <br /> ._ <br /> l <br /> 1 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, an rules and.regulations of the San Joaquin Local Health District. <br /> -_--------Owner and/or Contractor <br /> (Signed)------------- -- [ ) <br /> By-----------------------------•••-------------- I-------------------- --.-------------------------------------------------------------(Title)--------------------------------------------- --------- ------- <br /> (Plot plan, showing size of lot., location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 <br /> i FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ -----------Qv�..... ------------------------------------------------- DATE <br /> REVIEWEDBY----- ----------------------------- -------------- --------------------------------------------------- DATE----- � 1-.� --------------- <br /> BUILDINGPERMIT ISSUED---------------- --- ----------------- -------------------------------------------------- DATE---- --------------------------------------•------------- <br /> Alterationsand/or recommendations:- - -------- ---`-------- ------------•-----------------------------------------------------•-----•--------------------------------------- <br /> ---------- --------------•-------------------------------------------------------------------..-----•--•----------------------- •---------------------•------•-•------------------------------------------------------- <br /> ------------------------------- -- --------------------------------- - ----------------------- ------------ -------" -------- ---------•----------------------- --•------ ------------------------ -------- <br /> � T <br /> 5 :A 047 <br /> FINAL INSPECTION BY:. -------• . . --------- Date. r <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 145446 pTw000 12-54 <br />