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g3 <br /> APPLICATION FOR SANITATION PERMIT Permit No. _-tea`- <br /> - ----- <br /> (Complete in Duplicate) Date Issued .ac>_!7/_/72 <br /> Application 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 County Ordinance No. 549. <br /> JOB ADDRESS A OCATI N------/0574 f �a; 'a <br /> _? . A ------ <br /> ----------- ... ... ---;44i!t�---------------- <br /> Owner's Name-------- <br /> 412401U------f- - -- ------ ----- <br /> L --------- ---------- --- Phone------------------------------------ <br /> 022��� <br /> Address------------ -------- ------ ---- -------- 1-k-a-6 <br /> A__AOCATI ----- <br /> ........ .. <br /> Contractor's Name--------•-•-------------------.. E] Trailer <br /> ------------------------------------------------------------------------------------------- Pho'ne <br /> K --- ------------------------------ <br /> Installation will serve: Residence K Apar ent House 0 Commercial Trailer Court-E]_ Motel E]Other I <br /> Number of living units: J_ Number of bedrooms ___0_ Number of baths _0__-�Lot size <br /> Water Supply: Public system X Community system 171 Privat q*Depth to Water Table is ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel []..Sb-njy Loam 11 Clay Loam E] Clay El Aclobeg Hardpan ❑ <br /> Previous Application Made: Yes E3 No X New,C(5nsfructio Yes tlVo <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permiffed.'If-�ablic shiver i�available within 0 <br /> Se.ptic \ <br /> Ta D�stanoa'fr_o`m nearest well-- -------------Distance from foundation-------------------Materia-il---------------------------------------- -------- <br /> No�of compartments--- o000-----Size--------------------------------Liquid depth--- - 10.0----------------Capacity,---------------------- <br /> I sa iel Distance fr*6rp neaf.est w I ------------Distance from foundation------------------i!Distance to nearest lot line___.._-___..__... <br /> Number <br /> ine---------- <br /> Number of,.GesF��.t- "'--------------------Length of each line----------------------/_Width of trench----------------------------------- <br /> Type <br /> rench------------------------- --------- <br /> Type of filter mafer4al--- --------------------Depth of filter material__-_.___._ Total length__-____________-____________________._.-_ <br /> �sa iel <br /> Seepage <br /> ag pit. <br /> eepage Pit: Distance to nearest well-.--- ----------------Distance from foundation.A,/---.---.---.-------.Distance to nearest lot line________________ <br /> pfl ----- ---------------- <br /> El Number of pits----------------------Lj'nlrQ j�aaterial-----------------------Size! Diameter---- ----------------- De .... .......... <br /> foun <br /> Ces ol: Distance from nVerest well_______ <br /> &2i Distance from foun tion--- /_40-------Lining material----- <br /> a 14 I----Depth---------Size, D' meter------ - -- -- -- - -------------------------Liquid Capacity---- -00--------gals. <br /> D io a'n 6ie from nearest well-_______________________..______.__ --- _-Distance from nearest building._____-______.___________-__--.._____.___. <br /> ---------- <br /> ❑ Distance; o nearest lot line------------------------------------ --------------- <br /> ---A---------------------------------------;;Z----------------------------------------- <br /> 464 '01 <br /> Remodeling and/or repairing describe]:------- - ----- <br /> --------------- <br /> a <br /> ---------- - <br /> ------------------------------------Z--------- ------------------------------------------------------------------------- <br /> ------------------------------------------------------ �------------ <br /> n y4Z -- --------------------------------------------------------------N,-.-ii- ----- ---- -------------------- ------------------------------------------ ---------------------------------­­--------- <br /> I hereby certify that I have prepared -- ----- <br /> and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and r'epulafiorrs of the San Joaquin Local Health District. <br /> (Signed)------- -------- ---------6? ------"-------- <br /> ________________________(Owner and/or Contractor) <br /> By:-----------------------------•------------------------------------------------------------------------------------------------------{Title)------ ------------- ------- -------------------------------- <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---------------------------------------- - - - ----------------------------------- DATE------------------------- --ex <br /> REVIEWED BY-----------------------------------------------------------*­_1 DATE----- <br /> BUILDING PERMIT ISSUED----------------------------------------------- <br /> ----------------------------------- --------- DATE--------- --------------------------------------------------- <br /> Alterations and/or recommendations------------------------------------------ ---- -------------------------------------------------------------------------- <br /> ----------------------------------------------------I-----------------------------------------------­---------------------------------------------------•-----------------------•-•-----------------------.... ----------- <br /> --- <br /> FINAL INSPECTION BY:..____-------------------------------------------------------------------- ---------------------------------------------I---------------------------------------------------- ------------------------------------------------ <br /> ---------------------------------------- ----------­­­---------------------------------- ----------------------------------------------------I—---------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- ----------------------------------------------- <br /> V' 907,,/4 5�__.)-Z _S7�3 <br /> - -- ------------- -- -------------------------- Date-------------- - - - ----------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />