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\Y <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> A <br /> �piica-'-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> T . <br /> is application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS ARD -------1�---------'S)t�_ ------Il=---------------------------------------- <br /> Owner's Name_____<?°_-)9.___ ..... ------------------------------------ Phone------------------------------------ <br /> Address............ 69?7r_1.&--_--------_-------------- --------- <br /> _<-- - Phon------------­ ------- ------------ <br /> ------ --------------------------------------- -------•----. .._-.----------------- <br /> ­---------------------------------- <br /> Contractor's Nam <br /> Installation will serve: Residence 0 Apartment House E] Commercial F] Trailer Court E] Motel E] Other <br /> Number of living units: -V(-- Number of bedrooms 0<---'Number of baths_ Lot size -____________________ <br /> Water Supply: Public system [I Community system El .Private El Depth to WaterTable -------- ft. <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel E] Sandy Loam 0 Clay Loam ❑ Clay E] Adobe E] Hardpan ❑ <br /> Previous Application Made: Yes E] No [-] New Construction: Yes 0 No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: .. - <br /> (No septic tank or cesspool permitted if p blic sewer is available within 200 f <br /> Septic Tank: Disfance from nearest well -Distance--from foundation-- ---------- ------ ----- <br /> No. of compartments__-__ -----_------------ cl,p�h---Cif---!1�-------Capacity. <br /> Distance from nearest ull-4_0-------Dist #ifroo—C <br /> Disposal Field: ance foundafion_.2:57f._____.Distance to nearest lot <br /> Number of lines------- ---- Length of each line /4?0---------------WidA of trench.__..7L44"_______________ <br /> Type of filter materia _Depth --of filter material---JS""-.----Total length.....;:&A?-0----------------------- <br /> Seepage P' Distance to near eIj'V,1_/A----Disfance-%from founclation.-149.........Distance to nearest lot line.Zft�q014 <br /> - - --------Size: D la meter- Depfh--,Zr-------------------- <br /> Number of p;fs.---- -----------Lining material-It,_ <br /> Cesspool: D;sfance from nearest well-------------- --Distance from foundation--------------------Lining material__._-_______________.__-.________.._. <br /> ❑ <br /> aterial--.---------------------------------- <br /> ElSize. Diameter-------:------------------------------Depth----------------------------------------- ----------Liquid Capacity-------------------------•--gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nebrest building_______--__--__-----_-______.__-_-_-.____. <br /> ❑ Distance <br /> uilding------ ------ ----------------------- <br /> Distanceto nearest lot line-- -------------------------- ----------------- -------------------------------------- ----------------------------------------- <br /> Remodeling and/or repa;rin [describe):--`t ------ .......... <br /> COW. j4p. e-f — ------------------ ------------6----------------------------------------------------------------------- - <br /> ..... ----------- <br /> ....... -----....1 ~-- -------- -- -------fi............. <br /> --------------------------------------- ----- ----------­------------------- <br /> ----------- ---------------------------------------- <br /> ---------/K - - —y <br /> --- -------;-L-L--------- <br /> ---^f_ .- -')------------------------------------ -------- <br /> ir <br /> I hereby certify that I have prepared this application and that the wor will <br /> l be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed --------------_ &JUM--------------- ------------------ ---------- ------- -- ----------I---e,--- <br /> ... . ..... Contractor) <br /> Pft IN1111111 OV40 -------- ­- ---- ----------- Title)--- ---------- -------------------- <br /> As" - 31111101 6-00-2;-7046---------------- Ils,4�buiildings---- -------- <br /> (Plot pla6ming size of 151odom- jcetaftsysfern in relation to etc., c n be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------_---- - -- --- ---------------------------------------- ­----------- DATE <br /> ------------------ <br /> ----------- ---------------- <br /> REVIEWED BY--------------------------------- --- ---- ------- --- ------ ------------------------------ DATE-----------d- <br /> - ---------------- <br /> BUILDING PERMIT ISSUED------------------ ------- -------------------------------------------------------- DATE-------------------------------------------------- ---------- <br /> Alterationsa r, commen4atisons---- ----------------- ------------------------ --------------------------------------------------------------------------------7-------------------------------- <br /> ---------• ----------- ---- ------------------------------ <br /> ------------------*------------------------------------------------------------------------------------ <br /> - ------------ -;2 -----------------------------------------------------­--------•------------I------------------------------ <br /> rp <br /> ------------------------------------- <br /> ------------------------------------ ---------------- -------------------------------------------­­......... <br /> ----------------------------------- --------------------------------------------------- <br /> ------------------ ----------------- ---------------•------- ------ ............... ---------------- -------------------------------------------------- --------------------------------------------- <br /> ------------ Date------ <br /> FINAL INSPECTION BY:,---- ---- ------------------ ------------------------------------ <br /> �. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 S*06 American Street 300 West 0A Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES---9-2M 145446 ATWCOD 12_s4 <br />