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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local HealthDistrict for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549, <br /> JOBADDRESSAND LOCATION----- <br /> ----------- ----------------- t-- ---- <br /> I? <br /> A4Owner's Name Phone----`x". 97 <br /> ---- <br /> Address--------------------------- ................................................. <br /> :��--------- -- -- <br /> �Vc A xl- ----- <br /> Contractor's Name__r0_ . 4--- --------- <br /> ------------------------------------------------- Phone-A- <br /> Installation will serve:., Residence ��artment'House 0 Commercial 0 Trailer Court Ej Motel E] Other E] <br /> Number of living units: N- ber of bedrooms 4- Number of baths ___/Lot size <br /> --------------- <br /> Water Supply: Public system Community system E] Private El Depth to Wafer Table_ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 0 Clay Loam E] Clay E] Adobe� pan E] <br /> Previous Application Made: Yes El No P--: New Construction: Yes Ej No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:' <br /> (No septic tank or cesspool permitted if pu tic srer is available within 200 feet.) <br /> Septic T Distance from nearest wet Distance from foundaf;on_./99-7'�MaferiaI--- ?e—_(r_Jr <br /> A <br /> depth <br /> Na. of compartments--7 SizeSZ_!%r__316' _?�;71_icluicl -------------Capacity-- <br /> 5� <br /> Disposal F�ipW­ Distance from nearest _1� __Distanc; from founclation-J-P--------Disfance-fo nearest lot line_____®- <br /> Number of lines-_____r__ !1_04 fh _' each line-__9Z o e <br /> je--- eng of -- -----Width of french.__-23._Z11' <br /> F filter me -----------------.-Total length--- <br /> Type of <br /> __ -•-------- <br /> - <br /> ---- --- -----Depth of filter material---- <br /> Dist ance m j d't- Distance to nearest lot line._167 <br /> --- --------material . 03 pun a ion ------------ e.141 <br /> Seepage Distance to nearest wellwo <br /> Number of pits..____.___--""-- Lining ;�t -.Size: Diameter----In-----------Depth-----Z <br /> -------- ---- 40----------------- <br /> Cesspool; Distance from nearest well----------� Distarice from foundation- I----------- -Linin 4 <br /> ❑ Size: Diameter-------------- <br /> ------------- -j-----Depth------------- g material___________-------------------------- <br /> --------------I-------------------------Liquid Capacity- -------------------------gals. <br /> Privy: Distance from nearest well--.-..- ------------------------------- ----D;stance from nearest buildirig---------------------- ------ <br /> El Distance to nearest lot 1�ne'-r . - -I --- — r. ------- <br /> ----------------- -- ----- ------------- --_----------------- <br /> ----------- <br /> Remodeling and/or repairing (describe):"--------------------------------------_------_-_-- <br /> --------------I----------------------------------------------------- -------------------- --------------------- 'i--------- --------------------------------------------------------------------------------------- <br /> ---------------- ----------------------------------------------------------------------------------- <br /> ---------------------------------- <br /> --------------------------------------------------------------------------- <br /> -------------------------- <br /> -------------------------- ---------------------__-----------_.-g__- <br /> ------------------------------------------------­_--------------------------------------------------------_--------------------------------------- <br /> I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin Count <br /> ordinances, S Ws, and ruleVANd&effllg*s of the.San Joaquin Local Healt District. <br /> Septic Tank Service <br /> [Signed}_..---- ---HO-2-7,046--------- -------- ---- P._.,_t(9_wnvrmncVvr Contractor) <br /> Stockton, Calif. ----------------------- ... <br /> By:_- --------------------- -------------------------------------•----- - 1! 1 <br /> ------------------ --(Title __6 " <br /> (Plot plan, showing size of lot, location of system in relation to - V- Ae-e---------------- ---------------- <br /> Is, buildings, ei , can be 'placed on reverse side). <br /> J; <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- ------------------ --- -- - --------------------------------------- DATE------ ---------- <br /> ! BY--------"------------------------------ ----------- -----------------------------------------�'j..........------------ DATE ------------ <br /> ----------------------- <br /> BUILDING PERMIT ISSUED------------------------------- --- ------------------------------------------------------------------ DATE <br /> Alterations and/or. recommendations- <br /> -------------------------- --------------- - - <br /> ---- --- - - <br /> . ..... ----- .. ..... . .­ ­----- ---------------- <br /> 4 <br /> ------- ------ ----------- <br /> % -- --------------------------------------------------------------------------------------------------------------- <br /> - <br /> -- <br /> ---------------------------------------- . ... I--------------- ---------- <br /> --------------------- )1.1 ­7­�- ��` '� <br /> ----------- <br /> ---.,_�---A, <br /> ----------- <br /> ---- ---- --- %------------- -------------------------------------------- <br /> --------- ------------- <br /> 41Z <br /> , I . <br /> 7 ------------------------------------ <br /> FINAL INSPECTION BY----------- 4----- -------------------- Date 11._..-L------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 13D South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California ­"'Ivilanteca. California Tracy, California <br /> LS-9-2M <br />