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APPLICATION FOR SANITATION PERMIT Permit No. _---_���..... _ <br /> r (Complete in Duplicate) IIIssued __ . _Date .75_ <br /> Application is hereby made to tTh San Joaquin Local H a1th District for a permit to construct and install t work herein described. <br /> This a-pIication is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIOi.___----- __ --- __._ - , <br /> Owner's Name `'cx�tl------- Phone ------------- <br /> Address - - ---------------- / <br /> Contractor's Name____________ ____ iy /yp <br /> -=------------------------------- ----- •-------------------- Phone' d ,3--- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑1 Other ❑ <br /> Number of living units: 1----- Number of bedrooms -- = Number of baths ___{____ Lot size '_ <br /> ---------------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [v-*"Depth to Water Table 441 ft. <br /> Character of soil to a depth of 3 feet: Sand U Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 2 New Construction: Yes i?rNo,❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No septic tank or cesspool permitted if public sewer is available within.200 feet.) �€ <br /> =- -.'SepticTank': Distance—from -nea'rest--weH--._ T - ance from foanda#s�n_ -Mate _________�-_."._'._�_ .�____"__�_. <br /> No. of compartments--..._.-_.--_-_�_ �Size - Liquid de th_- - Capacity---------------------- <br /> a, <br /> Dspa d: Distance from nearest well--- ---.-- _Distance from foundation_s-----------Distance to neaprest lot line______--____- <br /> De th of filter material_._. . _._.._._.._Total length____,: <br /> Number of lines------------� t�� -Length of each line-------- �� -----------------•--- "_ . <br /> Type of filter material---L .LICf? .- p Width of S <br /> Ir - <br /> Seepa - Pit: Distance to nearest well...�_�O�_._______Distance fro foundation__._j_4____.___. istance to nearest lot li�ne�----_ <br /> [ number of pits. ---I ------------- gmate <br /> j _De �fn Lining matey}aL_! r $ize: Diameter 2--- - <br /> p 4 Lining l --" � 4 <br /> r� n <br /> Cesspool: Size: Diameter.nearest well --- -----Depthce-from foundafiion--------- ---- Liqud_Capacafy---------------------------- als. <br /> Pricy: Distance rom nearest well ... _____________ ____ _____________Distance from nearest building_.__:____.__._____.__________...____._._. <br /> ❑ Distance to nearest lot line-------------------------------------------- " -----------------------------------------------------IN---- ------ <br /> / p g wd __ • � <br /> R odelin and or re iri (descri L�"� �_ t.___.. ...!F----- R <br /> ^""-,It <br /> G _ <br /> -----------------••----•--.-------------------------•--------------••-•----•-----.-----------------•--•----------------------------------------.---------------------------------------- ----------•-•-----------•------- <br /> Ni ,4 <br /> ---------------------------•----------------------------------=-------- •-•------------------•------------------••-------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance withL <br /> , San Joaquin County - <br /> ordinances State laws, and rules and regulations of the San Joaquin Local Health District. ! <br /> (Signed �� Sewner and/or Contractor) <br /> By------------------- ��Id - {rile) - - �, . <br /> _ , <br /> Plot Ian, showing size f lot, location of.s stem.in relation to wells,.buildin s, etc.,,can be laced on 10 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY `�,,� ` -------- ------ DATE------ --- '". ' <br /> REVIEWED BY----------------- ----- ---- - <br /> f ------------------ DATE--- --� --- ._...-------- <br /> BUILDINGPERMIT ISSUED---------------------------------- .--W----------•---------- - •---------------------------- DATE---------------------- •--------------------- <br /> Alterations and/or recommendations:------------------ -- ------- ----------- ----------------•------------------ ----------•--------_------------------------------�------ ....... <br /> ------------------•--•------------------ --•----•----------- ................ --------------------------------------------------------------------------------------------------------------------------- <br /> ---------------- <br /> FINAL INSPECTION BY:. �; ------------------ Date_._../YI <br /> -f__ .. M <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Stre \ 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California '•\ Manteca, California Tracy, California , <br /> Es--g 145446 n-rwoao , <br />