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APPLICATION FOR SANITATION PERMIT Permit, No.__�..#7.. <br /> (Complete in Duplicate) <br /> Date issued <br /> 'Aalica�lion is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> ThisT in ce <br /> application is made ii� compliance with County 549. <br /> JOB ADDRESS AND LOCIO . ...... •------- <br /> ---------------- ---- -- --------- <br /> Owner's Name---- - ----- ------------ ---- --------- ---,- --------- ---- ---------------- Phone. <br /> e -------- <br /> Address---- / •-;1// <br /> V I <br /> . /17..... --- --------------- -- -------- .... ...11�_,--- --------------------------------------------------------------------- --------- ---------------- <br /> Contractor's Name.----- ---------- -------------------------------------------------------------------­------­1..... Phone_ <br /> z/il <br /> Installation will serve: esi ence Apartmen ouse E] Commercial [] Trailer Court ❑ Mofel [] ,Other El <br /> Number of living units: ----L Number of bedrooms j--- Number of baths/--- Lot size <br /> - ------------------------------------- <br /> Water Supply: Public system Community system E] Private [] Depth to Water <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam E] Clay Loam El Clay 0 Adobe Hardpan E] <br /> Previous Application Madi: Yes El No Construction: YeNo E] <br /> 1� 'IV/ <br /> TYPE OF INSTALLATION ANDI SPECIFICATIONS: A <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__�� Distance from founclation-- �_5�.---------- Material_--/_71_6 <br /> ---------- <br /> ice; c4al <br /> No. of compart ---- Lic�,icl clep�hF, <br /> ments.ne-------------- Size.e ---X.... <br /> X <br /> Disposal Field: Distance from nearest well.,19� -Distance from fcundation._,A��- -------Distance to nearAst lot line-------- <br /> --- ----- .----Length of each line........... ........Width of -------------- <br /> ----------- <br /> Number.of lines----- 74material---. ---_,f._____Tofa1 length________Type of filter material --------Depth of filter ilfh--------- --e---— ----------------- <br /> -It: Distance to nearest well________----- -------Distance from foundation--------------------Distance to es <br /> Seepage Pnearl t lot line_..___.._________ <br /> ❑ <br /> ine----------------- <br /> El Nunn* of pifs----------------------Lining material-----------------------Size: Diameter--------------.---._._.Depth----------- --------------------- <br /> Cesspool: Disfance from nearest well-----------------Distance from foundation--- ----------------Lining material-..'-Il---- ---- --------------------- <br /> ❑ Size: Diameter-------------------- - --- ----Depth--------------------'---- <br /> I I <br /> -------7-------------------------------Liquid Capacity'' -------------------------gals. <br /> Privy. Distance from nearest well------------------------- -----------------------Dista nce from nearest building----- ----------------------------- <br /> ❑ Distance to nearest lot line-------- -------- -------------------------------------------------------------------------------------------III! --------- <br /> Remodeling and/or repairing (describe) --------­-----­--------------------------- --------------- --------------------------------- <br /> ----------------------------------------------------------------­--------------------------------------------------------------------------------------------------------------------------11---------------------------------- <br /> -------------------------------------------------------I------------------------------------------------------------------------------------------------------------------------- ------------------- <br /> -------------------------------- --- ---------------------------------------------------------------------------------------------------------------------I--­------------ ---------- ------------------------------ <br /> I hereby certify that I have prepared.fhis application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat .laws, and rules and regulations 6f the San Joaquin Local Health District. <br /> -!Owner Z IAZ-_----—------------------------------------------------------------------------------------------------------ Ow a ontracforSigned)........... and C <br /> By:_-------------- j --- ------ ------(Tif le)----- ----------------------------- <br /> (Plot <br /> ---------­---------------- <br /> ----- ------------------------------------------------------------------------------ ---- <br /> (Plot plan, showingSze of lot, location of system in relafion to wells, buildings, etc., can be pla���everse lide). <br /> .1 <br /> FOR DEPARTMENT USE ONLY <br /> ,,APPLICATION ACCEPTED BY- -------------------------------------- DATE_.___._ - <br /> ----------------------------- <br /> REVIEWED'BY--------------------IN---------- ----------_-------- DATE-- �� <br /> ----------K,------------------------ -------- ------ - ----------------- -JI. --------------------- <br /> BUILDINGPERMIT ISSUED-----------------I-------------------------------------------*---------------------------------------- DATE V_ .11. ---------------------- <br /> Alterations and/or recommendations-------- --------------------------.------------_------- -------- ------------------------_------------------------- -------------------------------- <br /> ------------------------------------------------------------------------- --------------- --------------------------------------------------------------------------------------------------Ii-ji-------------------------------- <br /> ------------------- ------------------------------------------------------------------------------------------------------------------------------I--------------­----- ------------------------------------------------ <br /> ----------------- -------------------------------------------------------------------- ---------------------- ---------------------- -- ------- --- •---------- ------k----- ------------•....... <br /> ---------------------------------------II---- -------- -------------- ------ --- - --------­1----------------------------------- -------------------------------------------------------1_1-----------------------I---------- <br /> yIM <br /> FINAL INSPECTION BY:- - ------ - -----M-------------------------------- Date--------------------- <br /> SAN <br /> ate---------------------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Arneri6'an Stree't 300 Wes* Oak Straef 132 Sycamore Streef 814 Nor+h "C" Street <br /> 0 <br /> Sfock+on, California Lodi, California Manteca, California Tracy, CaliNornia <br /> ES---9-2M 145446^Twu DU 2-54 <br />