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APPLICATION FOR SANITATION PERMIT Permit No.1.3 <br /> .. . ......... <br /> x-4/�_ <br /> S(Complete in Duplicate) <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. —2_-�` <br /> JOB ADDRESS AND LOCA ----Of--- ----------- ---------- <br /> ------------------ Phone------------------------------------ <br /> Owner's Name--------•--•------------------------ ------G-m- r-^-Ky------------ <br /> ----------- r ----------------------------------- <br /> Address--- --------------------------------- ------ <br /> _77� <br /> Contractor's Name---------------------------pti" ---------------------------- —------------------------------------ Phone-17.7-:1 <br /> Installation will serve: Residence E] Apartment House [-] Commercial F] Tra %oF iler- Cou.rf Ej Motel E] Other 05444 <br /> ' 0-t4A.Pa Soo Sf&111_111 <br /> Number of living units: -------- Number of bedrooms -------- Number of baths Lot size 7- --------------------------------- <br /> Water Supply: Public system �Community system E] Private E] Depth to Water Table I/ <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam [] Clay Loam 11 Cl8yE1 Adobe X Hardpan 1:1 <br /> Previous Application Made: Yes Ej No g New Construction: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> $oic Tankt Distance from nearest well_________________Distance from foundation--------------------Material------------------------ ---- ----- _______.____,1 <br /> No. of compartments---------- ---------------Size--------------------------------Liquid depth---------------- --------Capacity--------------------- <br /> isrimsal F1�cl:, Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line---------------- <br /> - <br /> Number of lines-----------------------------------LLength of each line----------------------------- Width of trench--------------------------------.--: <br /> Type of filter material-__-_________________ Depth of filter material----------------------Total length---__-.__-____________ ______________-_.L----Distance fr f d f- ----- Distance to nearest 4 line---- Do <br /> Seepage Pit: Distance to nearest weAP-0-01 ?T un a ion <br /> j! <br /> ing ma eria _j_ 1 ""-----_Depth....41-0--------- ------ <br /> __Xqd�l Number of pits-----/-------------Lin f, , I .... Size: Diameter 1N <br /> Cesspool: Distance from nearest well-----------------Vistance from foundation--------- ----------Lining material_____-__--________.______.________ <br /> ❑ �. _ Size: <br /> aterial------------------------------------- <br /> Size: Diameter------- ------------------------------Depth----------------------------------------------------Liquid Capacity-- ---------------------- --gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------ -- <br /> ❑ Distance to nearest lot line- ----- - --------------------------------------•-- ------------------- -----------Z--------------------------------------------------------- <br /> Remodeling and/or repairing (describe): --------------------------------------------------------------------------------------------------------------------------------------------•---------• I <br /> ------------------------ <br /> ------------- <br /> --------------------_---------------------------------------------------I----------------------------------------- <br /> ------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------I............----------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------- ------- <br /> I hereby certify that I have prepared this application and that the work 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 /> (Signed)-------------P—,tk ------------------------- --- - ----- --------------------(0—m-awContractor) <br /> By:-------------------------------------------- ---------- ------------------------------------(T--i-f-I e)-_,V1 Z- <br /> --- - ------- --------- &;t77W-70- ----------------------- <br /> (Plot plan, showing size of lot, location of system relation tow buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------------------------------------------------------------------- DATE___ig�------- ------- <br /> REVIEWED BY --------------------------------- <br /> ---------------------------------------------- DATE----- - ------------------------------------------------- <br /> ---------------------------- <br /> BUILDINGPERMIT ISSUED---------------t-- ------------------------------------------------------------------------------- DATE------. (..A------------------------------------------- <br /> Alterationsand/or recommendations:--- ----------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> . .......... . ---------:7----------------------:------------ -------------------- ........ <br /> .......... ..................... ..........................L.,_-------:----------------I------------- <br /> ------------ ---------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------I------------------------------------------ ------- --- - - -------------------------I----------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------­­------------------------ ------------------ ----------------------------------------------------------------------- <br /> FINALINSPECTION - ------------------------- 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, Callfbrrvia Lodi, California Manteca, California Tracy, California <br /> ES-9-2M J4-52 Revised W-2100 <br />