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APPLICATION FOR SANITATION PERMIT Permit No. ...... <br /> (complete in, Duplicate) Date Issued --------- <br /> A ion'is hereby mad6 to the San Joaquin Local He6lth District for a permit to construct and install the work herein dscribed. <br /> gplcal, /4 3 2_0—5- <br /> 's application is made in compliance with County Ordinance No. 549. <br /> ;7 <br /> bL(b F7 ... ------ <br /> JOB ADDRESS AN�D�CATION A�'"--� �----- ----__TOwner's Name..----- --- - -------- ---- -------e----�A_x----------------------------------------------- ----------------- Phone. <br /> Address <br /> hone-Address------------140 -_L�- _----------- ------ <br /> ---------- Phone----------------------------------- <br /> Contractor's Name___ <br /> Installation <br /> .... ------- P� ------------ <br /> Installation will serve: Residence [5---,K—partment House El Commercial [] Trailer Court [I Motel 0 Other 0 <br /> Number of living units: _�----- Number of bedrooms -4--- Number of baths Lot size ------ z-------••------..._ <br /> Water Supply; Public.sys.fern -E] Community system'F1 Private ja Depth to. Water Table _Z4 ft. <br /> 1"M <br /> Character of soil to a depth of 3 feet:- Sand F1 Gravel rl Sandy Loam 0 Clay.Loam [3 Clay 0 Adobe Hardpan C] <br /> Previous Application Made: Yes F1 No E] New Construction: Yes a No El <br /> TYPE OF INSTALLATION AND SPEC-IFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ------------- -- <br /> --/4) -- <br /> Septic Tank: Distance from nearest weh__.f�Z5 Distance from foundation-. -- Material <br /> -.X - ---4------Liquid dep*_,_5Z- -------------Capacity YZ ------ <br /> No. of comparfmenfs.__,,1---------------Si,e__�� <br /> a— -01 <br /> :on _---------Distance to nearest lot Iin,__A5--------- <br /> Disposal Field: Distance from nearest well----- Distance from foundation--_--- el-------------- <br /> Number of lines-:-------/I---- Length of each line--------5��--------i------Width of french <br /> .Y-----?----------- 1 --------:2---5----------------------- <br /> Type of filter material---zS__--f-9/0— ePth of filter material------ if_Total length- -0 <br /> CY/ founqlation----/4t4�......Distance to nearest lot ------- <br /> Seepage Pit: Distance to nearest well--/-;F Distance 01 <br /> Depfh ,-_='�------------ <br /> Diameter------- <br /> Number of pits-----j----------------Lining material .... . i <br /> Cesspool: Distance from nearest well-------------------Distance from foundation--------------------Lining material--.--.-__-------------- als- <br /> ❑ - <br /> Size: Diameter A;----------------------- <br /> - -----------Depth----------------------------------------------------Liquid Capacity---------------------------g- <br /> Privy: Distance from nearest wel4 ------ -----r ---------------------------Distance from nearest building----._-----_-.---------------------- <br /> I -------------------------------------------------------------- ---------- - <br /> Distance to nearest lot line---------------------- -----•--- -------------------------------- <br /> Remodeling and/or repairing (describe):--------------------------------------- -----------•-------------------- - ------- <br /> -----------­---------I-----------------­----------------I---------------------- -------------------- ---------------------------------------------------- ........ <br /> ------------ ------------------------------------------------------------------- <br /> -------------------------- ------------------------------------------ <br /> I------- - ------------------------------------------- ----- --------- <br /> ------------------------------------- ----------I------------------------ ----------- -------------- <br /> -- ----- - -------- ------ <br /> ----- --- - ---------- ----- -------- - <br /> ---------I hereby certify_.that I.-have prepared. .-__th_.is-application- - .--- __and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law and rules a�d regulations of the S.an Joaquin Local Health District. <br /> ------------------------------------- ----(Owner and/or Contractor) <br /> ---------------------- <br /> - -- --- ----- -------------- <br /> (Sign6 -- ----- --------------- <br /> BY: <br /> (Plot plan, showing size of lot, location of system in r r elation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE----- <br /> APPLICATION ACCEPTED BY---- ----------- ------- -------------------------------------------------------- <br /> DATE------ ----------------------------------------- <br /> REVIEWED BY----------------------------------------------- --- -------------------------------------------------------------------------------------- DATE--------- ------ <br /> ---------------------­--------- <br /> BUILDING PERMIT ISSUED------------------------------ .7 ---------------------------- <br /> Alterations and/or recommendations:--_--------------- <br /> r <br /> ecommendations:------- ------ --- ------ --------- --------- --------------------------------------------------- \_ -----­---------------- <br /> 0------------------------------------------------------------------\ <br /> -- ------ -- ----- <br /> ------------- ---------------- L_ ._G11/2 - ----------------------------------------I--------------- <br /> ------------- -- -- ---------!77�----------- ------------ ------- ... ---------------------------------------- <br /> --------------------------- <br /> - -------------------------------------------------- ------------0------------------------------------------------------------------------------------------------ - -------- <br /> ----------- ----------- I - ----------------------------------- <br /> -------------------------------------- -- <br /> ---------- ----------------- --------- -------- - ---------------------------- ---------------------------- ----------------- <br /> Date. --------------•.._---__-----_--_-.-- <br /> FINAL <br /> ------------------------------- <br /> FINAL INSPECTION BY: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street in Sycamore Street 814 North "C" Street <br /> 130 South American Street <br /> Lodi, California Manteca. California Tracy, California <br /> Stockton, California <br /> E5-9-2M 145446 ATWUCD 12-54 <br />