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-A <br /> �n APPLICATION FOR SANITATION PERMIT Permit No.'s—a-1--- ..... <br /> / (Complete in Duplicate) Date Issued`:_/1/ _...._.9/ <br /> Applica+ion is hereby made to the Sen 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. <br /> JOB ADDRESS AND LOCATI ......W�NeG .----...----•---------•-----••------------------------------------------------------- <br /> Owner's Name......••-•---- ...... - -1 --!-- -------................... ...............-......... Phone...........................................--------.................... <br /> !d- ---- - --------------------------•--•-------------------..__..------------•- --- - ----------•------_...... ........Address _ J <br /> Contractors Name----..... ' -- ------ -------......------. ......................... ....... ---- .--- Phone). ..... <br /> Installation will serve: .Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel �❑/ Other ❑ <br /> Number of living units: ..-. Number of bedrooms a.. Number of baths J--- Lot size ....,7..-s '�.-. /SD-' - <br /> Water Supply: Public system ❑ Community system ❑ Private 2T *'bepth to Water Table Io. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑" Clay ❑ Adobe [Hardpan ❑ <br /> Previous Application Made:. Yes ❑ No ( New Construction: Yes 23""No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e <br /> Sept'T nk: N* Distance from nearest well_S�._-....'Distance rfrom foundation.../ --......Mat L--..._-.'...__ ...................... <br /> No. of compartments......... ...........Size. d_ .t1�Q..........--.Liquid ...........Capacity...B.0-0— 1 <br /> 1. <br /> Disposal Field: Distance from nearest well-47 "....Distance from foundation_*%.......Distance to nearest lot line i........� <br /> Number of lines.......A'..-.,..._..- Length of each line..(��....,..r�Q......Width of trench.....AY—ft.................. <br /> Type of filter meterial......V?6k.Depth of filter materia1 . ----.--Total length......... Z!�................-- <br /> Seepage Pit: Distance to nearest well..........".:`"....Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of pits......................Lining material.......................Size: Diameter........................Depth...............-.......-....... C <br /> Cesspool: Distance from nearest well.............:...Distance from foundation...._..............Lining material..........................----------- <br /> ❑ Size: Diameter......................... - -:Depth---------------..............-......------....Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well...................................... -------Distance from nearest'building.!..............._....._..-__............ 1 <br /> ❑ "Distance'to'nea rest lot line...........................----------....................r............------------- -`.-..-..........................................--.CC.. t <br /> Remodelin nd/or repairing (describe :------- ----e---------- ........._ ...............• --------- ...................' =-`-•- `............P. <br /> NA......................................--.............—.........._........................ .....---•----------------------.......... •---..........•-•---.....--•------------------------- ------------- - <br /> ------------------------.................-...........-.................................-.............................-_---------------------- ---................................................----------------- <br /> I hereb certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, ate laws,and rules and re ulations of the San Joaquin Local Health'District. <br /> (Signed)- .... -�- ..- ..... (O4ner and/or Contractor) <br /> By:--_---------------- -- .✓._.... ...... <br /> ,( <br /> (Plot plan, showing sae of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY- <br /> .... DATE------ -- ........-•---•---- <br /> APPLICATION ACCEPTED BY.'.'..:...... .. .. .. _ �..�--.-- <br /> REVIEWEDBY.----.-------.............------- - . . ..................................._.............................. DAT - •---- -------------•-----.._-- <br /> BUILDINGPERMIT ISSUED----...... .............................................._..................................... DATE.--.................-------------------------------- <br /> Alterationsend/or recommendations-------------------..............._............-•--••--•-----------------------................--••-•--•-----•--......---..........._----------- <br /> --..........................._......:..........-..............------------....--------------.-.._............_..................................._..........--..... ............................... . <br /> - .......................----...........I........I.......------ ............................................-................................................. -................................... <br /> - --.....---•--------....__........................................ ................................ --........-_...........-•----------.........• ---.....--•--•-----........................--- <br /> •-........................................................ <br /> .....-......�............I........I....................................---............_.............................--•---...._...............---....... <br /> FINAL-INSPECTION <'_`n...:'C_.".:... ........ Data. * -.7..-•-'..... ........--------- ........................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wert Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />