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APPLICATION FOR SANITATION PERMIT Permit No. - ------ <br />(Complete in Duplicate) <br />Date Issued <br />A '$plica'lion is hereby rade to the <br />I 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. 49. <br />JOB ADDRESS AND LOCATION........ <br />------------------------------ <br />Owner's Name ---- ------------------ <br />---------------------- ---- Phone -------------- <br />-A ------ --------------------- <br />Address_. --------------- ---1----------------- OCT - ----- Z, lj-li�' F".- 16�111� <br />- ------------- 7 --- ------ -- - - -------------------------------------------------- <br />Contractor's Name.----- f <br />- -------------- ------------------------- I ----------------------- Phone -4 <br />4-4 --- <br />Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court <br />El Motel Ll Other E] <br />Number of living units: ---- /-- Number of bedrooms j1'.- Number of baths' '.-/--- Lot size ---------- ------- --------------- <br />Water Supply: Public system W�'Communify system C] Private❑ <br />Depth to Wafer -- <br />--- <br />Table ft. <br />Character of soil to i depth of 3.feet: Sand E] Gravel E] Sandy Loam E] Clay Loam Ej Clay E] Adobe eHardpan L] <br />Previo4s Application Made: Yes El No �w Construction: Yes El No Ej <br />7 <br />1 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: t <br />(No septic'fanVor cesspool permitted if ppblic sewer is available within 200 feet.) <br />Septic Tank: Distance from nearest welJ19.&IC---- "D-fstance from foundation -10 ------ <br />------ Material ---- ClIf <br />No' of comparfm�enls ....... .14- 7' -Liquid depfh--4 Af -------------Capacity ---- -0Q__-_-- <br />5 <br />.. 1 7, -jr Zi -X.---- F <br />oral Feld: Distance <br />ce from nearest wel) ------ Distd' <br />KcTfrom foundation --------------- ---- Distance to nearest lot line----------------- <br />Number of lines --------- ------ ------------ Length of each line ----.---------.--------------.Width of trench.------ <br />Type �f filter material ----- - - --------------- Depth of filter ir�aterial --------------- <br />-------- Total length__..____.______.__________ -- <br />------------------------ <br />ache ifi <br />Distance f �fo­nearest from'foundation ------- ........ Disita"nce to nearest lot line___-- ------------- <br />mI ber ,of pits.-. ------------ Lining material -----------------------Size: Diameteir ------------- I --------- Depth --------------------------------- <br />Cesspool: Distance from nearest well___________ ----- Distance from foundation -------------- ----- Lining material___._.__._-_____--_..__--.. <br />r--------- <br />❑ <br />Size: Diameter -----I - ------------------ - r --------- =Depfh ----------- ------------------------ <br />------------ Liquid Capacity-, -------------------------- gals. <br />Privy:, Distance from nearest well -------------------------------------------------Distance from neare'sf building -------------------------- <br />❑-1 ibuilding--------------------------___--- - <br />--Distance to near-esf;lof line---- -------7 . I <br />---------- --------------------- : ------- : ------ ----------------------------------------------------------------- <br />Remodeling and/or repairing fdescr;be): ---------------- <br />- -------------------------------------------------------------------------------- -------------------------------------------------------- <br />-­-----------------­------- 5 ------------------------- I ------------------------------------------------------------- * ---------------- * -------------------- I -------------------------------------------------------- -- <br />------------- <br />--------------------------------------------------------------------------------------------------------- <br />rI I ------- ­ ----------- I-- ------------------------- -----•---------------------------------------------- - - --------------- :­ ------------- ­ ----------------------------------------------------------------------------- ---------------------------- <br />I t <br />here6pertify that I have prepared This application and that the work will be done in accordance with San Joaquin -County <br />ordinances, fa e lawl' <br />anrules4fS, regulations of the San Joaquin Local Health District. <br />d) ------- -- 12/144,4 <br />--------- ----------------------------„_-_,finer--ArRV-Dr-�C- onfracf or <br />Signed e2- - - % 1- -1 -1 <br />- -------- — - _71--c—l-el --- - -- -------- <br />BY:----; --------------- -1 ------------------------ I I - <br />--------------------------- ---------------- <br />(Plot plan, showing size' of -lot, T ------ J�4 ----------------------- (Title} Q_ <br />of system in re ation to wells,'' i ings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY__________ ------ --- --- -------------------------------- <br />-------------- DATE --- --------- -- -------------------------------- <br />REVIEWED BY ---------------- ---------- DATE ------ -- ------- -------- <br />------ ----------------- ---------- ---- - -----------------------------------------------------------DATE----------------- <br />---- ------------------------------ <br />- ------ ------ --- lk� --------- <br />-- -- -- --------------- <br />----------- ------------- <br />------- --- <br />BUIL61NG PERMIT ISSUED---------- ----- - ------------- ---------------------- ---------------- DATE ----------------- --------------- <br />--------- -- -- ---------------- ­ -------- ---------- <br />Alterations and/or recommendations------------------..._ ------ <br />---------- ---------------------------- ---------------------------------------------------- ---------------------------------------------------------------------------------------- -- -- ---------- <br />----------------------------------------------------- ----------- .. ------------ -- ------------- -------------------------- - 4 <br />--------------- I -------------- ------------------------------------------------------------------------------------------ : ------- ---------- I ---------- <br />---------- ­---------------- j ---------------- ----- ------------------------------ --- I -------------- ------ --------------------- ----------------------------------------------------- N --------- <br />---------- ------------------------- ------------------------ <br />-1 ------------------------------------------ ------------------------------------------------------------------------------------------------------- <br />F I N A L - I N S P EC T 10 N - B Y:., 0, -5; --- — ----------------- - ------- 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 />I <br />ES -9-2M Rev:'ad W-21.00 <br />