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APPLICATION FOR SANITATION PERMIT Permit No. _// - -------------- <br />(Complete in Duplicate)7 <br />Date Issued <br />Application is hereby made to 'the 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. 549. <br />JOBADDRESS AND eLOT N! ------ ____ --------- ------- -------------- I ------------------------ -------------------------------------------- <br />Owner's Name_____________ <br />------------------ Phone <br />Address ------------------------- 1:12.yjjq ------- 61v' -------- ------ --- <br />Contractor's Name------------------------------- 1_•16� A---- ------ ---------------------------------------------------- Phone. <br />Installation will serve: Residence EffApartment House [I Commercial [-] Trailer Court El Motel (3. Other ❑ <br />Number of living units: J---- Number of bedrooms __Number of baths -*? ----- Lot size _________________ <br />Water Supply: Public system E] Community system El Private E] Depth to Wafer Table <br />Character of soil to a depth of 3 feet: Sand [-] Gravel [] Sandy Loam E] _C�ay Loom E] Clay [] Adobe 21 �Hardpan El <br />Previous Application Made: Yes [] No Ep-New Construction: Yes B-< ❑ FHA/VA: Yes E] No E4�� <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or' cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tpk: Distance from nearest well ,04"_ Distance from founc1afion___,Jj0_./ --- MiateriaI ---- r__e__,eR /_G_ 0-4 ---- <br />2, ---Capacity--S---------- <br />---------- -�Z --------- <br />No. of compartments________ ----------- Size___"_,Y_$/a --------- Liquid dep�h --- :!�K� ---------- Capacify--S ------------- <br />Disp I R Id: Distance from nearest weh,0944ALDistance from founclation/a ---- ------ Distance to nearest.lot line, -75 ------------- <br />Number of lines____________________ / ---------------- Length of each line_-_______ �;!D ------------- Vidth of trench_ .,OP�_ /I <br />----------------------- <br />Type of filter mate ria I- _______Depth of filter material -l -e ---- - ^_/ Total length________ ______------_____ fes_.__ <br />Seepage Distance to nearest well_- - ---- . ance ro ation ------ Distance to nearest lot line__._____._. <br />Number of ---------- ening material_)r,0,d-& ` ------- ize: Diameter ..... 3j ----------- Depth ----0.4 ---- ------- <br />Cesspool: Distance from nearest well__________ ____Distance from ation --- ---------- .--_Lining material______._________________________----- <br />F1Size: Diameter --------------------------------------Dep Dep ---------------------------------------------------- Liquid Capacity ----------------------------gals. <br />Privy: Distance from nearest well ------------------------------------------------- Mstance from nearest building ----------------------------------------- <br />❑ Distance to 'nearest lot lire----------------------------------------------------------- ------------------------------------- --- ----- <br />RemodeVg and/or repairing Ve ------------ ------- I <br />------------------------------------------------------------------------------------------------------------------------------- <br />------------------------------------------- 4 .... ------------------------------------------------------------------------------------------------------------------------------ <br />------------------------------------------ ---------- -D's - .., ---------------------------------------------------------------------------------------------------------------- <br />Tance 'ron d <br />ning material_)' <br />_11 ........ ...D f �i <br />__ D <br />I hereby certify that I have prepared.this application and that the wolirk 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 />{Owner an <br />(Signed]--------------------- ------- le --------------------------------------------------- (Owner an or Contractor) <br />.... . ..... <br />By: --- ---------------------------I ---------------------{Title] - ------------------------------ <br />(Plo+ plan, showing size t, lo ation of system in relation to we i <br />- - - --- 7! wells, .2dings. etc., can be placed on reverse side]. <br />��/- <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY-------------- ------- -- ---- - - ------- I __ -- -- ----- --------------------------------- DATE ------- 7-- -;: .--. - - — - - — .W-5- <br />----------------------- <br />REVIEWED <br />----------------------REVIEWED BY --------------------------------------DATE------------ --------- -------------------------------- <br />BUILDINGPERMIT ISSUED__ ---------------------------- ----- ----------------- ---- ------------------ -------------------- DATE ------------------------------------------------------------- <br />Alterations and/or recommendations:------- ---- ---- ----------------------------------------------------- ­-•---------------- -------- <br />PC- ---- TIT! �b <br />_________________________________)711 - ----- DF -P -c -i - ---------- ------ - ------ K ---------------- /_EAI�A ---------- ------ ------ <br />---------- I ---------------------------------------------- ------------------------------------ <br />---------------------------------------- - I -------------------------------------------------------------------------- <br />-----------I------------------------------ --- --- ----------------- ----- --- -----------,----------------------------------------------- <br />----------------- -------------------------------- -- ----- -- -- ---------- --- ----- ------ <br />--- -------------- ------------------- -------------------------------------------------- <br />FINAL INSPECT\IGN BY: - D -ate ........ <br />-------------------------------------------- <br />130 South American Street <br />Stockton, California <br />ES -9-2M Revised 1.57 f.P.CO. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Lodi, California Manteca, California Tracy, California <br />