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APPLICATION FOR SANITATION PERMIT Permit No, <br /> 5-7 /\J +-7,J�0_ (Complete in Duplicate) Date Issued W-3-ty-L <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 County Ordinance No. 549 <br /> JOB ADDRESS AND LO ep_r_Vt� <br /> _ TION -----As 1 ------------------------------------------------- <br /> Owner's Name------------ ..... <br /> ----k---- ... ... ...... --------- --------------------- ------ ------------ -F Phone------------------------------------ <br /> Address------------------------ - --------- <br /> -- -------- --- <br /> -- - -- -- ------- - --- ---- - ------------ ---- -------- Phone_---------------------------- <br /> Installation will serve: Residence partmerif House F �Ora ii I Court '0 Motel E] Other E] <br /> Contractor's Name_-_-_ ' ------- ------ -D <br /> Commercial er C <br /> Number of living units: -------- Number of bedrooms A,_ Number of baths Z-_ Lot size 13,7._X__/YY-------------------------- <br /> Water Supply: Public system E] Community system El Private 2r"bepth to Water Table 0-"ft. �t'l <br /> Character of soil to a depth of 3 feet: Sand Gravel [] Sandy Loam Clay Loam [] Clay E] Adobe Jj��ardpan E]41' <br /> Previous Application Made: Yes E] No ��New Construction: Yes ;_�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_;7A_'4---- --Distance from foundpkion_e� ---------- <br /> No. of compartments-----ll--- Sizef_�/--- ...Liquid depth_... <br /> 01 5/------------------Capacity __4------------- <br /> - ------/ _ I <br /> Disposal Field: Distance from nearest well___ Distance from foundation-..fP .--------Distance to nearest lot line___ <br /> 19 Number of lines___.___ Length of each line------6-0...............Width of french---6A_ <br /> --.__...__.Total length___-__-_ , _____________________- <br /> 44_.�­ "aferial----- <br /> Type of filter maferia epth of filter M <br /> Seepage Pit:l Distance to nearest welVi20" .--'---Distance from foundation--------------------Disfance fo nearest lot line__'5�----------- <br /> a <br /> Number of its.. —------------Lining maferial-ii,407!5�-R----Size: Diameter_ -----------Depfh--..249...................... _Z) <br /> Cesspool: Distance from nearest well____.___.-- ----_Distance from foundation----------- ___._._.Lining material--------------------------------------❑ <br /> Size: Diameter---- - -------------------- -------�'_Depfh------------------------------ -- -- ---------------Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well_______________________________.__---------- --Distance from nearesf building.___________-__________--_-.-.-.._ ._._. �J _ <br /> ❑ <br /> uilding------------------------------------------ <br /> F-1 Distance to nearest lot line--------- ------------------- ------------------------------------------------------------------------------------------------r-------------- <br /> Remoderng and/or repairing (describe):_ ----- ------------ ------------------------------------------------------------------------- ------------------------------------------ <br /> ------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------- <br /> --------------------­--I.,---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- ------------------------------------------------------------------- •---•---•-•-------------------------------------------•--------------------------------------------- <br /> I hereby certify that I have,.0prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat and ules. and regulations of the San Joaquin Local Health District. <br /> 14 <br /> ...and ..... . . .. ..... <br /> (Signe ---- ----- --- ----- ----------------- ------------ -- _-—-------------------------------------------- -----(Owner and/or Contractor) <br /> -------------------- <br /> By:----------.............................------------------------------------ --------- ----------------------------------------------(Title)----- .....q-. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DAEA"EN� E ON <br /> APPLICATION ACCEPTED BY---- DATE----- <br /> -------------------------- <br /> REVIEWEDBY---------------------- ------ -- ------------ ------- ------------------------------------------------------------------ DATE------------------------------------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------- DATE-.-.-.---- ---------------•---------- <br /> ------ --------------- <br /> Alterations and/or e 2renddafip ......... •-,••,-••---_-• <br /> 2 ............ <br /> ----------- ------------------- ------------------------------------ -------- ---7'77:_ <br /> ---------------------- --------- --- <br /> --------------------- -------------------- ------------ ------------ --------------------17 ----------------------- r- <br /> ---------------------------------------------- ------ ------ ------------------------------- <br /> - ------------------------------------------------------ <br /> --------- <br /> ------------------------------------- <br /> FINAL INSPECTION BY:---- ---------------- Date---.- .__ <br /> -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 7 <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lod-L, California Manteca, California Tracy, California <br /> E5-9-2M 145446 ATWUCD 12-54 <br />