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No.N <br /> Permit APPLICATION FOR SANITATION PERMIT Perm . . ........... <br /> (Complete in Duplicate) Date Issued --- <br /> 0 <br /> Applica4-I ion is hereby made to the Sinn Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in complian wit C unty Ordinance N 549 <br /> 'I" ! .. . .. <br /> JOB ADDRESS AND LOCATION.. ... --- ............ ---------•-------- <br /> Owner's <br /> -- ------ <br /> Owner's Name-- 4-A-------- _. . - - _'�7=--- ---------------------------------- Phone------------------------------------ <br /> Address-----Z& ---------- ----- --------------- --------------------------------------------------------- <br /> Phone---- ------ <br /> Contractor's Name_- .. ...... ------------------------------------------- <br /> Installation will serve: Residence MA' <br /> Apeament House [3 Commercial E] Trailer Court ❑ Motel ❑ Other El <br /> Number of living units: I--__- Number of bedrooms 7-7-1-Nomber of baths,*_------ Lot size _XV(S-0---X_2�_O_q----------------- <br /> Water Supply: Public system Ej Community system [I Private [IlDepth to Water Table AvYff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loam C] Clay Loam El Clay El Adobe &-r-,rJp­an 0 <br /> Previous Application Made: Yes F1 No oFstruction. Yes F-1 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se c T nk: Distance from nearest well---_-.---.------Distance from foundation-------------------Material------------------------------------------------- <br /> .. No. of compartments------- ---- -------------Size--------------------------------Liquid depth------------------ -------Capacity---------------------- <br /> Dis os I I ie" Distance from nearest well----------- Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Number of lines-----------------------------------Length of each line_--------- ------------------Width of trench----------------------------------- <br /> Type <br /> rench--------------------- ------------ <br /> Type of filter material-------------------------Depth of filter material----------------------Total length----------------------------------------- <br /> ance fLpm founjation____40�9 IF nearest lot line-- <br /> eepage Pit: Distance to nearest well_._��.l-------Dist --------Distance to <br /> Number of pits---/----------------Lining maferial__)�o -Si . 10'.-----Depth--2,r <br /> _-Size: Diameter— ..... - ----------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--- _.------------ Lining material----___--_----------------_____----- D' <br /> ❑ Size: <br /> aterial------------------------------------- <br /> Size: Diameter--------------------- ------- - ------Depth------------------------------ -- ------------------Liquid Capacity----•-----------------------gals. <br /> Privy: Distance from nearest well...___._-.--_-------------- _---...-_.....Distance from nearest building------_--__---.----.---------__--..-.----. <br /> ❑ <br /> uilding------------------------------------------ <br /> ElDistance to nearest lot line--- - --------------------------- - ------------------------------------------------------------------------------------------ --------------- <br /> Remodeling and/or repairing (describe):------------------------------ ----------------------------------------------------------------- -------------------•------------------------------..-.-. <br /> ----------------------------------------------------------------------------------------------------------------------------­----------------------------------------------------------------------------------------- <br /> -1-------------------------------------------------------------------------------------------------------------- <br /> ------- ----------------------------------------------------------------------------------------------------- I....... <br /> ------------------------------------------------------------------------------------------- -------------------•--------•------- ------------------------------------------------------------------------------------------- <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 to IqLs. an and re lations oft San Joaquin Local Health District. <br /> (Signed)- --- ---- ---- ----------------------------------------------------------,(';�nar amA-i(pir Contractor) <br /> .00" ------ <br /> -------------------------------------- ------------{Title)------------- <br /> (Plot <br /> -----------(Title)--------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--- - ------------- ------------------ ---------------------------------------- DATE-------.-­------------------------------------------ <br /> REVIEWEDBY---------------------------------------- --- --- ----- ---------------------------------------------- ----- DATE------ ------1�-------------------------------------------- <br /> DATE----.- ----------------------------I------------ <br /> --- --- -- ------- - --- N\ *\ <br /> BUILDINGPERMIT ISSUED-------------------- -- -- ------ -------------*----------------------------------------- <br /> Alterations and/or re mmendations.............. ------- ---- - ------__--------------------------------------------------------------------- -------\ ------------------------- <br /> 0-n -------------------- -----------­----------- <br /> --------- - --------- I ,_. 7 ___' ----------------- <br /> '4 0 - -- -- -- -------- --- <br /> ------------------------ ------------- -------- ------------ --------------_----- <br /> - - --- -- ------------------------------------------- <br /> --------- - ----- --- ------ - - --------e .... -------- ------ --------------------- <br /> ------ --- --------------------------------------------- -------- -------- ------------------------------- ------------------ <br /> --------- -- ------ ---- --------I------------------------ <br /> ----------- - --- ---- -------- ----------------------------­--- ------------- -------------------------------- --------------------------------- -------------------------------------------------------- <br /> FINAL INSPECTION BY;.- ----------------------------_--- Date_//--l-T-4 --------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 110 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 ATWCQD I2-54 <br />