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lyl�. <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued --- <br /> 43—3 oo—t <br /> plica-lion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> $1 <br /> This application is made in compliance with County Ordinance No. 549. 3 J5 <br /> &'Th <br /> j. <br /> JOB ADDRESS AND CANON -------4-e- <br /> e,7 Z----- <br /> / <br /> Pone--;;Owner's Name-----,C _ <br /> Address-------------------- <br /> ------------------- --------------------- <br /> -- <br /> - ---------- --------------------------------------------1_111**----------- ------- <br /> �A -------*--------*------------- <br /> _7 <br /> ------ ----------- ------------------------------- Phone----------------------------------- <br /> Contractor's Name__.... ----/1-C.& Z�� <br /> Installation will serve: Residence ''"Apartment House E] Commercial E] Trailer Court [] Motel E] Other El <br /> Number of living units`___ Number of bedrooms Number of baths Lot sizeZC------- ----------------------- <br /> - <br /> Wafer Supply. Public system [] Community system [] private 'Depth to Water Table2_o__/ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam P"Clay Loam 0 Clay El Adobe E] Hardpan ❑ <br /> Previous Application Made: Yes E] No � New Construction: Yes n--Iqo 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu6lic sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.�_47-------Distance from foundation-----le---------Material___0,._,&-_ ------- <br /> No. of compartments__- ------- ------ -----S i Z e iw'�Z,7 A7----Liquid depth,_,O'�g----------------Capacity---- 9?------ <br /> Or <br /> I Field: Distance from nearest <br /> Disposal -----Distance from foundation--- .... Distance to nearest lot line__-------------- <br /> 93-17 Number of lines---------------- 'Length of each line------- ------- --Width of trench-...-**. 4d <br /> ---------- --------------- <br /> Type of filter material.- Z aferial__Af............Total length___-____7 ____'M�'Depfh of filter m _"----_---------------- cb <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> F-1 Number of pits----------------------Lining material--•--------------------Size: Diameter-----------------------Depfk---------------------•----------- <br /> Cesspool: Distance from nearest well-_.__--_-__--___--Distance from foundation____----__-________ Lining material______________________________________ <br /> ❑ <br /> aterial-------------------------------------- <br /> EJ Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well---------------- --------------------------------Distance from nearest building_._-______.__.____.__-_.._____.________._. <br /> ❑ Distance <br /> uilding------------------------------------------ <br /> Distanceto nearest lot line. --- -------------------- - -------- - -------------------_-- ---------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe): <br /> -------------------•------------•--------------------------- <br /> ----------dir�u- <br /> -----------­-----------­­­--------------------I------------------I-------------------------------------------------------------------------------------------------------------------------------------------- -------- <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 /> -------------------- --------(O�7Ser Contractor) <br /> By:..................... <br /> ------------------------------------------------------(Title)----" <br /> (Plot plan, showing size Abl lot, location of system in relation to wells, buildings, etc., can be placed on reverseside). <br /> -- <br /> A - ---------------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ;ZBY-- ­ ---------- -------­1------------------------------------------- ----------------------- DATE'S <br /> �7 -S---------------------------------------------- <br /> REVIEWEDBY--------------------------- ------------- ---- - -------- --------------------------------------------- DATE__�- ------------------------------------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------ <br /> Alterations and/or recommendations:---------------------- -- --- ------ - - ---- ------ ----------------- -------------------- <br /> -----------------------------7-------------------------------- <br /> ---------------------------------------------------I---------------- --------------------------------------------------------------------------------------------- ------- --------------------------------­---- <br /> -------------------------------------------------------------I----------I--------------------------------------------------------------- ---------- ----------------------------------------------------------I--------------- <br /> -------------------------------------------------------I-------­-------- - <br /> ;;;�7-------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------- ------------------------- ------­ ------- ---------- --- ----- /---------- ---------------------------------------------- ------------- ----------------------------------------- <br /> FINAL INSPECTION BY--------------- ------ -------- -- Date.......... - -------------- ­-- ----- ------- ------------------------------ <br /> ----------------- <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 /> 4 <br />