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/y <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..29 .___- <br /> (Complete in Duplicate) $� <br /> Date Issued ___IF ___ <br /> Applica+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 made in compliance with it Ordinance No. 549. <br /> JOS ADDRESS AND LOj <br /> ___------- ri `------•---- <br /> Owner's Name-------------------------- --- - --- - -- -- ---• ----- "y <br /> JOB <br /> ----- ----- <br /> -------- ----- ----- Phone------------------------------------ <br /> Address----------------- - --------- <br /> -- -- ---------------- <br /> Contractor`s Name ���. -- --- ------F' -- - --- -- Phone- - ----- - _ <br /> Installation will serve: Residence partment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:#_______ Number of bedrooms _x+__ Number of baths ---I--- Lot size ------ � __-_-___--__._ <br /> Water Supply: Public system ommunity system ❑ ' Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �Fl@..rdpan ❑ <br /> Previous Application Made: Yes o ❑ New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r <br /> l <br /> Se p is Tank: Distance from nearest well__ ___' __Dist nce from foundation---- > <br /> Material- 'd�'7 '�=` ---- <br /> No, of compartments___________ ��- Zic_2--_-_Liquid depth____- /,..� Capacity__ _ <br /> Size <br /> Disposal_.Field: ` Distance from nearest well............. nce from foundation---,__._._-___ _ .Distance to nearest lot line____-____________ <br /> Number of lines------------------ -------------Length of each line -----------------------Width of tr __-_-•-- <br /> Type of Vier materi ------------------Depth off r material-----_-------------____T t ngth------------_.----_-•--------------------. <br /> Seepage Pit: Distance to nearest well_----_----------------Distance from foundation....................Distance to nearest lot line----__--___-____- <br /> ❑ Number of pits----------------------Lining material---------- -- Size: Diameter------------ - -Depth--------------------------------- fi <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_.________________-________________ "1 <br /> ❑ Size: Diameter--------- ------ ----------- - ------ Depth------------- ----------- --Liquid Capacity--------•-------------------gals- \� <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building-------------.______-_--______-__-___----. W <br /> ❑ Distance to nearest lot line--------- - --------- ------ - -------------- - ------------------------------ <br /> Remodeling and/or repairing (describe)----------------------------------------------------------------------------------- -- <br /> -••---•-------•----------------------------------------•--------•-•---- -------------------- ------•--- --••--•-----. - •-. -•----------------------------------------------------•-•----------------------- <br /> -------•------•------••--------------------------------------------------------------------------------...................•--------------------------------------------------------------__----- <br /> ------------------------- -----------------------I--------------------------------------------------------------------------11--------------------------------I--------------------------------------------------- <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, State laws, and rules and regulation f the San J . quin Local He h District. <br /> Si ned -_ �' �t = �_._.: ----,-- -- _ ---_�Ly -� ---------- -----Owner and/or Contractor <br /> ( g }y 17 <br /> .[Title} ) <br /> $ :.- --•---•---------- ------------ <br /> (Plot plan, showing size of I , location of system in rel on to wells, buildings, etc., can be placed on reverse side). <br /> a <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- --------------------------------------------------------------------------------• DATE'- -------------------------------------------------- <br /> REVIEWEDBY----------------------------- �J----------------------------------------------------------------------------------- DATE-- <br /> BUILDING PERMIT ISSUED---------------------------------- -------------------------------- --------------------------------._ DATE_._��.,� - - <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------•----- -------------------------- <br /> _--•--------•-•-----•--•_-•------•------------------------------------------------------- ----------------------------------------------------------------------------------------------------•------------•---•-------------- <br /> FINAL INSPECTION BY: - ------ -- bate �`� .. <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 /> 1.N 145446 ATW ODo 12-54 <br />