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t -APPLICATION FOR SANITATION PERMIT Permit No. ----7 <br /> (Complete in Duplicate) 5 � ' <br /> Date Issued <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 wits, County Ordinance No. 549. <br /> JOB ADDRESSAND�I ATION------^' y�C�.._ ......... -°------- .------------------------------------- <br /> . ._... Phone _ . _ .3..Owner's Name.----- ----- -`71P <br /> Address............�� . 'l! ......._.. --•--•------------------------------------........ -•--------------------------------•------_------ <br /> r^ <br /> Contractor's Name �7 lsl C` --------------------------------------......................... Phone.:[7__Z-.�_C�___2--•------- <br /> Installation will serve: Residence U9—Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----/_ Number of bedrooms -_-_',Number of baths ----/-- Lot size _--_-73 -��---�d-�_----_.-- <br /> --------------- <br /> Wafer Supply: Public system ❑ Community system ❑ Private [!�-­Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 5--Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [E--New Construction: Yes ❑ No [!I--. <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 wel{-----------------Distance from foundation-------------------Material--.---------.--.__._--..-.------_.-.-----____._.. <br /> ❑� �s �c'��No. of compartments------------------ ---Size------------------------------- <br /> Size---}----•---•------------------ Liquid dept--------------------------Capacity-._------ <br /> Disposal Fiel : Distance from nearest well--- S._....-Distance from foundation-----� _---..Distance to nearest lot line_------___-- <br /> �fXJ �'� umber of lines__________... _. Length of each line------ _-U-_� Width of trench._-__?_Y"_'___-_.___.--_-__ <br /> -qd�. , �� n <br /> Type or filter material_---/�X ....Depth of filter material-_----4---(__.__Total length---.-yd_`------------------------ <br /> Seepage Pit: Distance to nearest well d.-.--_-__Distance from foundation__r23.......... <br /> Distance to nearest lot line___ ........ <br /> !r <br /> E4--' Number of pits--- ------Lining material-_-ff SSG .Size: Diameter__. ---- Depth.... •.r <br /> -------------------- <br /> Cesspool: Distance from nearest well-------- --Distance from foundation....`............. Lining material--..__--._.__------.-----------__--_. <br /> ❑ Size: Diameter--- --------------------Depfh----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------------------ - ....Distance from nearest building------------------------------- <br /> ❑ Distance to nearest lot line--------- ------------------------------------------------------------- -------------------------------------------------------------------- - <br /> Remodeling and/or repairing (describe) C Gr�1�i-6�7-�----------y!��-`.�----------------------•-------------•-•------•--------------------------------- <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 /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> [Signed� <br /> �i�,PR�s,/ �----------------- <br /> ------------ <br /> ---------------------------- <br /> C- ------ <br /> ----l �___ ner and/or Contractor) <br /> BY= gy ;. --------------- ------ --------------------- (Title) f <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ------------- -�7 ------- -- ---------------------------------------- DATE_-----�--------------------------------------------- <br /> REVIEWEDBY---------------------------------------------- - � � v ------------ ------------------------------------- DATE------------ --- --------•---------------------------- <br /> BUILDING PERMIT ISSUED------------------------------ �- ------------• DATE. - �. <br /> ----------------•--------•------ ---• <br /> Alterations and/or recommendations---------------------- <br /> v <br /> .� <br /> -------------------------- <br /> _r- <br /> -------------------------------------- -------.-----------------------------.-------------------------------.----------- -___..____--_._---_-_----.__-_---__-- ------------_-----_--- <br /> FINALINSPECTION�BY:�-------- ----- --------- -------------- Date---- ----------- ----------------- - ---------- ------------------ <br /> SAN <br /> - -------------•SAN JOAQUIN LOCAL HEALTH DISTRICT <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-9-2M 145446 A7W[3SD 12-54 <br />