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64 APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete in Duplicate) D Issued to <br /> _3 ­0 <br /> ��P-P�Iil- tion 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 compli nce with County Ordinance No. 549. m <br /> JOB ADDRESS AND LQC,111ZTION--------- <br /> -- -------------­/1e__,.-h--U---- <br /> Owner's <br /> U----Own'er's Name------ <br /> Phone <br /> -------- --------- ------ <br /> Phone.- <br /> Address - -.41 <br /> /-- - ------- ------ -- ------ --- <br /> -----------I-------------I-------------------------------------- <br /> Contractor's Name_ <br /> -----Apartment_ - - ---- - ------- --------------------------------------------------------- ---------------- Phon',_21__!D----/Ct__cp <br /> House E] Commercial El Trailer Court E] Motel ❑ Other <br /> Number of living units: -------- Number of bedrooms Number of baths --I---- Lot size Pa� <br /> Installation will serve: Residence d : <br /> ---------------- <br /> Water Supply: Public system E] Community system E], Private P6­15epth to Wafer Table <br /> I <br /> Character of soil to a depth of 3 feet: Sand El- Gravel.[], Sandy Loam E] Clay Loam Clay'E] Adobe Hardpart <br /> ❑ <br /> Previous Application Made: Yes E] No n New Construction: Yesg'No F-1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic is-111f. Distance from nearest well_/0_0.......Distance from foundat' <br /> Mate I----A <br /> Er No. of compartments-------*---------------Size-_IX 1,0<5---------Liquid clepth------yi <br /> Disposal Field: Distance from nearest aresf well--- Distance from foundation.... - ----------- apacify- ---------------- <br /> , lin ........Distance to nearest lot lin <br /> ofP X I I ---- ---- <br /> Number es- Length of each line----ems. ----------------Width of trench----- --- ------------------- <br /> Type of filter ma­t,,r­;,6-q,-.-_ Depth of filter material---- ------------Total length------- '112 1 <br /> Pit: ir ;1--------- <br /> SeepagXll Distance to nearest wel)—f-0--------Disfanc fr9rn fpun6ation___ZZ')_`_____ Distance to nearest lot lim <br /> Number of pits.-- ----------Lining rndferiZ1_#_ Size: Diameter---- 9-1-------------- t <br /> V----------------Depth...-----�_24............... <br /> Cesspool: Distance from nearest well-----------------Disfance from foundation_____------ Lining maferial----------------- ------------------I <br /> ElSize: Diameter------------------- -------------------Depth-------­­-------------------------------- - ------Liquid Capacity— I <br /> I --------------------------gals., <br /> Privy: Distance from nearest well---------------- - -----------------------------Distance from nearest buiiding----------------------------------------- <br /> El Distance to nearest lot <br /> ------------- ----------------------- <br /> -­---1---------------------I------------------------------------------------------------------------ <br /> A;- --------- <br /> Remodeling and/or repairing (describe): <br /> -----------------------6---------------------------------------- ------*----------------------------------------------------------------------------------------------------------------------------------I---------------------- <br /> ----- ------------------------- <br /> ----- <br /> - <br /> ------------------**------------I---------------------------------------------------------------------------------------------------------------------------- <br /> I <br /> ------------------------------------ ----------- <br /> ---------------------------------------------------------------------------------------------------------- -------------------------------------------------------I hereby certify that I have preplared 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)---- --------Rlir�W_•�-------- ---- ------ --------------------------------------------------------------------------------------------(Owner and/or Cgntfracfor) <br /> ------------- <br /> -----------47AI-2 ....... <br /> ­ --------------------------------------------------(Title) <br /> By:------------1.9, <br /> (Plot plan, showing size off lot, location: of system in relation to wells, buildings etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> --------- ------ <br /> APPLICATION ACCEPTED BY--------- <br /> -------------------- ---- -- ------------------------------------------------------- DATE-------------- <br /> _T -2 <br /> -------------- -- <br /> REVIEWED BY------------------------------------------------------- -- ------------------------------------------------------------------- DATE----------- 7- <br /> BUILDINGPERMIT ISSUED------------------------------ - -------------------------------------------------------------------- DATE------ <br /> Alterations and/or recommendations <br /> ------------------------ --------------- -----------I------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----­--------- <br /> -------------------------- -----------------------------------------------------------------------------------------------------------*----------------------------------------------*--------------------- <br /> ----------------------------------- ------------- ---------------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------- - I <br /> ------------------------------------- <br /> FINAL INSPECTION :6Y:.. K--—--------------- Date---------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 30D West Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca.,CaliforniaTracy, California <br /> ES-9-2M )0-52 Revised W-2100 <br />