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t., f: v APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica4ion is hereby made fo the San Joaquin Local Health District for a permit to const uct and install the work herein described. This application is made in Compliance with County Ordinance o. 5 . . ......... ___ ------------------------------------------------ JOB ADDRESS AND 1_09�TION--------- J_V/ - ------- --- . . .......... ... ... ---- Phone------------------------------------ - - - - ---------------- -------------- Owner's Name----------- 504�1�. --------- jp? ---------- - - -- A -- ------ -- -- ----- ----------- ------- --------- - ------------------------ ---- ---- --------- X _k -------- Address ---------------------- - -- - ------- ----- Contractor's Name---------- Apartment House 0 Commercial Trailer Court ❑ Motel Other Installation will serve: Residence al E] Number of living units: __-F-__ Number of bedrooms _1< Number of baths -------- Lot size ----- - ------ •------- Water Supply. Public system Ej Community system 0 Private E] Depth to Water Table ft. Character of soil to idepthof 3 feet: Sand ❑ –Gravel ❑ San . dy Loam 0 Clay Loam El Clay 0 Adobe A�ardpan 0 Previous Application Made: 'Yes E] No F1 New Construction: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank-:' Distance from nearest .well__- ___.__--____ Distance from foundation -------------------- Material -------------------- - --------------------------- 0. of 6orrpart4ents ----- ------------ ize --------------------------------- Liquid depth-------------------------- Capacity -, -------------------- I /P I., Disposal F�i Distance' from nearest -wellA.041d-Distance from founclafion--l.?d ---------- Distance to nearest lot line Ap ------- Width of tren �/ El Number! of Iines__4r_1.5.1 . ..... p ...... �__Length of each line ----------------------------- c� -------- 0? -- ------------------ �e al I k -------- Total length -------- ------------------- Type of"filter maierial.-S, WM? Depth of filter materi ------- Seepa' e Pit: Distance to nearest we4A/,_.� Distance from fQfindation_4 ------- . Disfancefo nearest lot line__ - ------------ N . umber o� ------- Lining maferialAt -_ - - ! --- Size: Diameter__,,t----------- Depth-------- --------- ❑4 Cesspool: 151stanc6 from nearest well ----- -------- --Distance from foundation --------------- ----- Lini I ng material__-------.__--____.__-_---__-__ ❑Size: Diameter --- 11 -- ----------Depth-------------------------------- -- I -- --------- ------- Liquid Capacity ---------------------------- gals. ----------------------- Privy: Distance from nearest well --- I ----------- --------------------------------- Distance from nearest building_-_--_._____-----___________--__.._----_. ❑ Distance uilding----------------------------------------- Distanc: to nearest lot'line_ --- --------- ---- ---------- i ------ ------------- P ------------------------------------------ -- ---------------------- ------------- ------------- - Remodeling and/or repairing (describe):----------- - --- ----- ---------- -------- --- - ---------- ---------- -- ------------- --------------••---------••------------------.------------------------ 000- ----------- ---- ----------- ----------- : ---------------------------- -1 -------- --------- --------- ----- / -------------- --- --- - A ---- - ------------------------------------------- -7 --------------------------------------------------------------------------- --------- --------------------------------------------------- ---- I --------- ----------------- I hereby certify that ]'have prepared this application and that . +he work will be done in accordance h San Joaquin County ordinances, St atesjnd rules and regulations f,,;.+Thne San J:,,aZqu n Local Health District. 44t (0 t lContractor) (Signi--------------------- . .......... -------- ---- - o:: -- ------------------------------- ------------------------------- Dd)� _------ A --- (Title) P1 --------------- By: ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY, DATE-- ------------------ ----------------------------- D --- APPLICATIONACCEPTED BY-------------------- ------ ----------- ------------ --------------- -------------------- REVIEWED BY --------------------- ----------------- ------- -- ----------------- ----------------- ------------------------ DATE----- ------ - --------------------------•--•----------- - ------------- %,.. , BUILDINGPERMIT ISSUED----------------- ---------------- ---------- --------------------------------- ------------- DATE-------- -- -------------------------------- ----- ------------ I ----------- ----------------- ----------------------- ------ ------------------ Alterations and/or recommendations: -- ---- --- ---------------------------------- --------------------------------------- \___ -------------_----------- ------------------ ----------------------- --------------------------- ----------------------- ------------- ---------------------------- ---------- . ----- ----------------------- ---------------------------------------------------------------------------------------------- I - ----------------------------------- ------------------ -------------------------------------------------------------------------------------------------------------------- --------------- ------------------------------------- I ------------------------- I --------------------_- ------------------------ --- - -------------------------------------- ----------------------------------------------------------------- ------------------------------------------------------------- ---- I ----------- 4 - 4,�s7- FINAL INSPECTION By Date-------- )"--~- ----------------------- ----------------------------------- ---------- ------- ------------------------- ------- 130 South American Street Stockton, California ES -9-2M Revised W-2100 SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California