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- ----------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued __131V <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 ne County Ordinance No. 549. <br /> -------- ------ <br /> JOB ADDRESS AND LOCATION__.;�/'zor,"4�/ <br /> ----------- <br /> Ph <br /> Owner's Name------ <br /> - -------- ---------------- -------------- Ph ------------- ------------------- <br /> Address---- ......4?14�� <br /> ---------------------------*--------------------------- <br /> Contractor's Name_____________A Phone <br /> Installation will serve; Residence El Apartment House E] Commercial ❑ Trailer Court Ej Motel El Other <br /> Number of living units: -------- Number of bedrooms -------- Number'of baths -------- Lot size ----------------- ------------------------------------------ <br /> Wafer Supply: Public system El Community system [] Private Ej I Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand I-] Gravel E] �andy'Loam.�fl Clay Loam L] Clay E] Adobe El Hardpan E] <br /> Previous Application Made: Yes E] No &--TNew Construction�Ye;"W��, o F1 <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_________________Distance from fou7iclation----f--------------Materi6l----------------------I-—------------------- - <br /> El No. of compartments--- -----------Size-----k------------- -------Liquid'depth------ -- ----------------Capacity------------------------ <br /> #-------------- <br /> Disposal Field: Distance from nearest well.................Distance from foundation------ Distance to nearest lot line.____________-___ (1 <br /> ❑ <br /> ine----------------- <br /> 171 Number of lines-_---------------------------------Length of each line------------------------------Width of trench----------------------------- ----- <br /> Type of filter material______--._______________Depth of filter material----------------------Total length_______...___--___-.__________________., <br /> Seepage Pit: Distance to nearest well..Ak-it.-K�_-"'Distance from fo ^dat1on___.---�_ _.__.Disfance to nearest lot line--' <br /> ,0 , - I --------------- <br /> Number of pits____,______________Lining materia/ ......�Size: Diarriefer----�_eeO <br /> 11 z=' , ---Depth___2e--------------- <br /> 5- <br /> 0� I , <br /> Cesspool: Distance from nearest well_________________Distance from foundaf io,n--------------------Lining material-____.__----_.____._________-__-__ <br /> ❑ Size: <br /> aterial------------------------------------ <br /> Size: Diameter--------------------------------- Depth------------- -------------------- -----------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well___________________________________ <br /> --------------D;sfance from nearest building------------------------------------"----. <br /> ' ❑ <br /> ui)&ng------------- ---------------------------- <br /> r Distance to nearest lot line------------------------------ ---------------------------------------------- <br /> Remodeling and/or repairing (describe):----- � <br /> ------4 �, -------------- --------- <br /> - -----------------------------------------------------------4'-------- --­----------------------------------------------- --------- <br /> ---------- ----------------------------- <br /> ------------------------ ----------------­-- <br /> -—-—--------------------------------------------------- --------------------------------------- <br /> ---------- <br /> -------------------------------------------------------------------------------------------------- -------- ------------------------------------------------------------ ----------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> &.0 <br /> -ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------------ge'V' ------------------------------------(Q*rfk2iMAZ& Contractor) <br /> By:.r_--------_--------------------- ------_--------------------------(Title)-- ---------------- <br /> (Plot plan, showing size of lot, 1 . _%_sfem in relation fo wells, buildings, efc., can be placed'on reverse4ell <br /> ., ;c y <br /> FOR DEPARTMENT USE ONLY <br /> ,APPLICATION ACCEPTED <br /> &' BY--- J--- ---- ---------------k-------------------------- DATE-------- <br /> - ----J------C--->---- <br /> ----------------- <br /> - <br /> REVIEWED BY ------------------------ . .............. ----------------------------------- -------- DATE--------- ----------- - <br /> , BUILDING PERMIT ISSUED-------------------------------- DATE, <br /> -,' Alt a9c or recommendations:.----- 1474-11------- <br /> f!------ <br /> ------------ <br /> ..... . ------- I.. A'R—A xft <br /> -------------------------------- <br /> -------------------------------------------------------------------------------------------- ---------------------------------------- ------------------ -------------------------------- <br /> ------------- ------------------------ ................. , <br /> FINAL INSPECTION BY:---------------- PI-sn-.4. ---------------------------------------- ------- --------------------- <br /> - <br /> SAN JOAQUIN LOCAL-H EALTH'DI STRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> Es-9 145446 ATWDMD <br />