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Y <br /> 11 APPLICATION FOR SANITATION PERMIT Permit Na. <br /> (Complete in Duplicate) Date Issued __- /- �•S 7 <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.- Qr7 r- <br /> (UJ <br /> _f�" •---------------------� ` <br /> ----------- <br /> -------------------------------------- <br /> JOB <br /> ' <br /> JOB ADDRESS AND-LOCATION-------- g5/s <br /> y e_ vl C� Phone_- <br /> Owner's Name-------- - ------ ----- ------ ------ ------- <br /> ---------­------------------- <br /> ------ fi <br /> /� ----------•--------------------`.�---�--------------------- <br /> Address <br /> -----•----------•-�---•••- ------------- "_...------ --- - / <br /> -------•---- ---- <br /> Contractor's Name_.. -- -------- -•-- - ---- ------ -- ❑ <br /> Installation will serve: Residence Apartment House ❑ Commercial Trailer Court [I Motel El Other ❑ <br /> . r y o7 -------•----------- <br /> Number of living units: -/.-_ Number of bedrooms " Number of-baths ""1".- Lot size ----- <br /> Water Supply: Public system: Community system ❑ Private Depth to-Water Table a ft/"Character of soil to a depth of 3 feet: Sand E] Gravel ❑¢1Sandy 'Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan <br /> Previous Application Made: Yes ❑ No D�New Construction:—Yes 10 ❑ ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No septic tank or cesspool permitted if public sewer is available within 200 feet.} *- <br /> �" ----------Material- ' --;-- - --------- <br /> Septic Ta k: Distance from nearest well"y5--_.-----Distance from foundation"-. "_� <br /> • p tY � � <br /> No. of compartments-- ------------Size" "-""-.Liquid depth_y ----------Ca aci <br /> Disposal F' ld:h Distance from nearest well--! !--.-Distance from foundation->20......... <br /> �" ..Distance•to nearest lot line----------------- <br /> Dispos�a,IF' <br /> -1------------------ Length of each line-----`-�- 6 --:------Width of +Tench".�y�� <br /> Number of lines"""._"" <br /> r ---- , - s <br /> Type of filter material"s' �T Depth of filter material"--� �f ------Total length--------------- <br /> • �5-f <br /> Seepage Pit: Distance to nearest well.-.- ""___. Distance frim foundation" "`Q."_"_""".Distance to nearest lot lined": "__---" p <br /> Lam` <br /> Number of pits-----_�------------Lining material_ .-""--- -------- Size: Diameter"--- ---.Depth--. - ------_"""-- <br /> Cesspool- Distance from nearest well-.----------------Distance from foundation-----------:-_ Lining material.__.""".."- <br /> Size: Diameter --------------- :_,".Depth-"=---`-------- -- `-------- --------------- Liquid Capacity _- gals. <br /> ❑ Distance from nearest well---------- from building __-""_-.-_"""_----------.-------------• <br /> Privy: ,. -------------- ---------- <br /> Distance <br /> to nearest lot line------------------------ - - ----------...-------..-"---"- "-•- <br /> El <br /> - ••------...L""`'------ ------------------------------------- <br /> Remodeling <br /> -__---•__---------------•_----._.. <br /> Remodeling and/or repairing (describe):---,------- --- ------------"------ �" <br /> ------------- <br /> --- <br /> -------------------------------------------- ------•--------------------- - <br /> ---------------------------------- = - <br /> Thereby 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 les and regulations of the San Joaquin Local Health District. m (. <br /> t <br /> '----- <br /> {Owner and/or Contractor} IN <br /> (Signed) f.. ' <br /> e�� �, ------------------------------- ---•--------------•.(Title) !------=------------ <br /> By----------------------P----- <br /> (Plot pian, showitig.size of lot, location of syst in relation to wells, buildings,eta., can be placed on reverse side}. ' <br /> FOR DEPA_ RTMENT-U_SE ONLY = r <br /> v F DATE----- --- ---- �-t / <br /> APPLICATION ACCEPTED BY--- A ------ <br /> ----- ---------------- -- <br /> . `DATE-----�%-- <br /> ----------------------------------- <br /> REVIEWED BY . DATE------ ------ -------- ---- <br /> BUILDING,rPERMIT ISSUED _ < <br /> Alteratti�ionss'and/or recommendations:--- _ - <br /> J'' (� f w r-- 1 — .. <br /> f <br /> ----- -------- <br /> " --- - - <br /> ------------ ----- <br /> ---•-------------- <br /> ------------------------- -----•---------------- - <br /> ---------- <br /> __ <br /> r -�- Date"a' ---------------------- <br /> -------- --------------------------- <br /> FINAL-INSPECTION BY ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oat Street 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street Trac California <br /> Stockton, California Lodi, California Manteca, California y, � <br /> gg�g 145x46 A7WOOO <br />