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I: <br /> APPLICATION FOR SANITATION PERMIT Permit No. -----------f............ <br /> (Complete in Duplicate) Date Issued -�.Y -_1. S_5 !f <br /> - <br /> Applica4ion 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 County Ordinance No. 549. <br /> JOBADDRESS ANP LOCATION + -- ---------- -- ----------------------------------------------------------•---------..---------------•---------------- <br /> Owner's Name -------------- .------------- -------------- --------------------------------•----------- Phone------------------------------------ <br /> Address_._ ---------- <br /> ....-"" -- <br /> Contractor's Name ---------------------- Phone '" _ __ # <br /> Installation will serve: Residence &--Xpartment House ❑ ,Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I <br /> Number of living units: Z__ Number of bedrooms Number of baths . ___ Lot size -- __ .___.K--1-1-0-------------------- <br /> Water Supply: Public system A- Community system ❑ Private ❑ Depth to Water Table 6,Pff. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: Yes ❑ No E4--Y4ew Construction: Yes I . <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 ort___Distance from foundation--- -45_....__.Material__ ________ ___________ _____________ <br /> No. of compartments-----�-----------°---Size �__X._W__�------Liquid depth-! - - -------------Capacity-r' (gip�++.-------- <br /> &_f Distance to nearest lot line___s�-__�_ <br /> Disposal Field: Distance from nearest weliC,Y►.W_s_._.._Distance from foundation--- __._. ____ <br /> Number of lines___._______ Lbngth'of each line--- ------ Width of trench._;.-°�________________________ <br /> Type of filter material__. - <br /> Depth of filter material-------- _+ ..._ Total length____ ___________________________ .00 <br /> ro <br /> Yp p <br /> Seepage Pit: Distance to nearest well, " --__-_ nc rom o ation----- ......Q'stanf <br /> ._ _ <br /> e to nearest lot line-______ S+ <br /> Number of pits--- /_____..__ ___Lining m Leri I_ . ize: Diameter.3�----- Depth__ � <br /> .._� ___________________ <br /> Cesspool: Distance from nearest well-----------------Distance rom foundation.... - -............Lining material.------------------------------------- <br /> El Size: Diameter-- ----------------------- -----------Depth------------------------------------------- --------Liquid Capacity ---_-.gals. <br /> Privy: Distance from nearest well--------------------------------------------.----Distance from nearest building-_--______._..____-___________------_..._.; <br /> ❑ Distance to nearest lot line----=-----------------------•-------------------------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe)------- -- ---------------------------- --------••---------------------•-------------------------•--------•------------------------------:--------- <br /> ------------•--------------•---••----------------••----------------------------------------------------------------------•---------- _--- •-------------------------------------------------------------•------- <br /> •--------------------•-------------------•---------- ------------------------ -•-----•----------------...----------------------•-•------•--------------------------------------------------------------------------- <br /> .{ <br /> -------------------------- --------------------------------------------- -----------------------------------•--------------------------------------------------------------•----------•-1-------------------------- <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, an rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-..-- -------- -- ------------ ------------------- - -------------------------------------------- ----------------------- Contractor) <br /> By: - --------.-------------------------------------- (Title} - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> �� <br /> APPLICATION ACCEPTED BY---- -- - - <br /> -- --- ---------- --- --------------------------- /�-----------------------.- DATE-- �-- -----r--- --------------- <br /> - -- <br /> REVIEWEDBY----------------------------------------- - -----------------------_------------------------------------------------------ DATE------------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---- ---------------•-------- ------------------------------ <br /> Alterationsand/or recommendations:--------------------- -----------------------•• --------------------------•--•--------•--------------.._...- ---•-----•------ ---..------- <br /> ------------­----------------------------------- <br /> -• ----------•-- 4 --�- ----------I--------�-s,---- ---- - ------------ --------------------------------------------------------------- ------------------- --------------------------------- <br /> I <br /> --------------------------- -- -------------- ----•--------------------•-------------- <br /> FINALINSPECTION BY----- -------------- --------------------- a Date- ------------------ -4--------------•-----------------•-------•-•---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South•American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street <br /> Stockton, California Lodi, CaMornia Manteca, California .Tracy, California / <br /> E5-9-2M 1x5446 AT-D 12-4 - ,• - �f <br />