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1s� <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> {Complete in Duplicate) �/ / <br /> . Date issued ___._.?-/._!-_S„c- <br /> Applica4ion 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 Count Ordinance No. 549. _ <br /> JOB ADDRESS AND LOCATION. <br /> ----------- Rs ------------------ <br /> ------------------- -------------------------------- ----------------------------- <br /> Owner's Name_ -�Q C4S°. ' s =�` M- -------------------------------------------------------- ------------------- -- Phone' <br /> ----------------------- -----------------------------------------------------------------•- <br /> ---------------- <br /> 00 <br /> Contractor's Name. Phone-.--:3►3 qx? <br /> Installation will serve: Residence Apartment Hausa ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_k Number of bedrooms .At - Number of baths --1--- Lot size__. ? .___. r }-------------------------- <br /> r <br /> Water Supply: Public system [Community system El ••tt Private ❑ Depth to Water Table �`-rft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Ly Clay Loam E] Clay E] Adobe Hardpan C]Previous Application Made: Yes❑ <br /> ' '' No L��,/New Construction: Yesoam No ❑� <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 foundation-------------------Material------------------_------------------------------ <br /> oNo. of compartments--------------------------Size--------------------------------Liquid depth------------ ---- --------Capacity--------- ------------- <br /> Disposal al Field: Distance-from nearest weli................. <br /> Distance from foundation--------------......Distance to nearest lot line.--------.--_-_-- <br /> Number of lines----------------------------_------Length of each line-----------------.---------._.Width of #ranch_._.__________.___ <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ <br /> Seepage <br /> --------------------_-_----_---__-------- <br /> t <br /> p ge Pit: Distance to nearest well:. _,#_�AL--_-.--Distance from foundation__�MAL'4a__.Distance to nearest lot line__ _--_--. <br /> See . Dumber of its._f------------------Linin material_.4L.K--.._.Size: Diameter-- <br /> 3.!,. � p 9 3.!------ ---Depth- --2'.,t'�-------------•--- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material_-.-._.____-___--------___.-----_--_. , <br /> 0 Size: Diameter----- ----------- -------------------Depth----------------------------- ----------- --- --Liquid Capacity <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-.__--_-__---.---_---____ <br /> ❑ Distance to nearest lot line ---------------------------- ---------------:---- _...... <br /> Remodeling and/or repairing (describe):___-- .. ___ _....._ �__. <br /> -------------- •--------•---•---------•---------------------•-----------.----- <br /> ------------------------------•------•-----------------------•------•----•--------•-------------------•----------•-------------------- <br /> -- <br /> -----------------------------------------------•-----••------•I-----•-••--------------------•---------------------•--------------------------•----•------------------------•-------••--------•-------------------•---- ---- --- <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 /> -- ------------(Owner and/or Contractor) <br /> By:---•- - -"--------------------- -----------------------------------------------------Tale <br /> (Plot plan, showing six 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 B DATE -- -------------------------------------------- <br /> REVIEWED BY-------------------------- DATE---Z��------------------ <br /> BUILDING PERMIT ISSUED------------- ----------------------------------------------------- ----- <br /> Alterations and/or recommendations---- ------------------:---- �----------- -•------------------------------- <br /> i <br /> -----------------------------------------------•----------------- -----...------------------------------------....-------------------------------------------------••-------------------------•-••--•-----•----•-------- <br /> --•----------------------------------------------------------- ------ - ----------------------- --------- ------------------- - <br /> ---------------------------------------------------- --------------------------- -- --------;­----------------------------------------------------------- -----------------------------------------• ------------------- <br /> FINAL INSPECTION � �s ------------- Date.:. ---�------ <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT i <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 /> E5=9 igsgq6 pT wp,3p • i <br /> i <br />