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APPLICATION FOR SANITATION PERMIT Permit No, <br />(Complete in Duplicate) <br />Date <br />Applica;'ion 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 Cirdinaam No. SAO - <br />JOB ADDRESS AND LOCA'TU10..__A.__L/eZ_7 <br />---- I - -_ -- ­ I I ----- -- ---- ----- --------------------- ---------------- ------------------------ <br />Owner's Name-----'' A,� <br />__ ___ .4 <br />. ........ L ....... <br />-------- ---------- ---------------------------- - Phone -----------------------------_ <br />Address-- <br />Contractor'sPhone <br />Installation will serve: Residence 0-00Apartment House E] Commercial [I Trailer Court E] Motel L] Other M <br />Number of living units: ---I --_ Number of bedrooms .-2— Number of baths __I ---- Lot size _Za- ----- A_L2n(7 <br />Water Supply: Public -system &_0161mmu6ifY system El private 0 Depth to Water Tableft. <br />Character of soil to a depth of 3 feet: Sand El Gravel D Sandy Lo r am El Clay Loam ❑ Clay-ardpan E] <br />❑ Adobe &-H- <br />Previous Application Made: Yes F1 No 9"New Construction: Yesh-No ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank: Distance from nearest wei lf11kes,0,__ Disf6 n6e' from fcUndafion -------14 ---- 1--.Maf6rial ------ <br />------------ <br />No.!_of compartments--------_ Size- -44 ------ Liquid depfh---- Capacity. - <br />Disposal Field: Distance from nearest well??0%n-,,4_.._Disfance from foundation ---f _1 ------- Distance to nearest lot line---- ---------- <br />Nu' ber of lines ----------_I ----- Length of each line ------ 2 --- 0. _;--------- Widfk of french ------- 2-- <br />T ' <br />T.filfermaterial___ - I . _j__ -_Depth of filt' <br />-- filter mateFial-_-. ----- ------ Total length__/_2A5 --- / ----------- <br />------------- <br />T�Pe Ol-- <br />Seepage- Pit: Distance to nearest well---- ------------- 4 -Distance froml f'c;un'dafion ------------------_ Distance to . nearest lot line--__------____--_ <br />Nu , 'mber of pits------ -_---_ Lining 'rrnaferial ------------ -------- Size: Diameter,---_- _ ---------------Depth-------- --------------- ------ <br />/ 7-i - <br />Cesspool: Distance from nearest well --------------- =_D'isfanceN, from foundation-_--_---_____----- Lining material--__-----_--------___-_ Size: Diameter------------------------------ ------- Depfh---------- r ------------------------------------------Liquid Capacity----•---------------- ---- gals. <br />Privy: Distance from neare5t ;iell ------- -- ---------------------------- --------- Distance from nearest building -------------------- <br />El ..Disfance-to nearest lot line----------------------------` ---------------------- - <br />Remodeling <br />ine--------------- <br />Remodeling and/or repairing (describe):_-_--------------___ I ----------------------------------- <br />---------------------------------- --1 ---------------------------------------------------------- <br />-------------------------------------- ------------------------------------- ------------------------------------------------- <br />----------------------------------------- -----------­-------- I --------------------------------------------------- ----------•----------------•-------------------- I ------------ "__­ --------------------------------------------------------------• •• ------------------------------------------------------------------ I ----------------------------* ----------------- * ---------------- <br />I hereby t certify that -I have prepared this application and that the work will be dome in accordance with San Joaquin County <br />ordinances, Sff Uffel�w , and rules and regulations of the San Joaquin Local Health District. <br />--- ------------ --- -- ----- -- Nrner 9;11;Mr Contractor) <br />----- . ... . ..... <br />(Signed). ..... . <br />_ _ - - --- ----- 11 ---------- -------------------------------- <br />By: ------ - 0-K A V. - ele - 4_1 _.�. �__ � -------------------------------------------------------------(Title)- -- e4;?L �__ - za� ......... --------------- <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY DATE <br />REVIEWED BY --------------- j ----------------------- <br />------------- --------------------- ---------------------------------------------------------- DATE ----------- - ------------------- <br />BUILDING PERMIT ISSUED________ ---- ------------ ------------------------------------ ------------- DATE ----------- <br />ns: - ----- --- <br />Alterations and/or recommendations:- -------------- <br />--------------------------------------- ---------------------------- ----------------- ---------- ---- ------------ --------------- <br />------------- <br />--------------------------------- <br />---------- ------------------------- --- ------------------------- ---------- ----------- ­_ --------- ---------------------------------- -1 --------------------------- --------- --------------------------------- --------- <br />---------------------------------------------------------------------------------------------------------------------------------------------------- : ----------------------- ----------------- -------------------------------- <br />-------------------------------------------- ----- --------------------- ----------------- * ------------------------------------------------------------------------------------------------------------------------------- <br />FINAL INSPECTION 'BY:.-- ...... _- - --------------------------------- - Date <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 />Es= -9-2m ; Revised W-2100 <br />kal <br />