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APPLICATION FOR SANITATION PERMIT Permit No. <br /> -2_3 <br /> - _ /_ <br /> scr. <br /> ,b <br /> (Complefe'in Duplicate) '�!_ ' "I <br /> Date Issued__ <br /> Application is hereby made to the San'Joaquin Local,Health District for a permit to construct and install the wor ' rein described. <br /> This application is made in complianc/e with County-Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION----- <br /> A—___', 64 <br /> ------—---—------ - - -------- --- ------- <br /> -------------------------------------------------- <br /> J, 1-11 <br /> ---------�1------------ ------------------- Phone....C_r4__4V4--------- <br /> Owner's Name------------- ---- <br /> 01 147"_*7 <br /> Address---------------------------f?�- -J.--------- 49�------/IX) --------------------------------------------------------------------------- <br /> --------------------------------------- <br /> /Contractor's Name_.A_ -------------f�-------------------ki:7: <br /> -------------------------------------------- Phone....... -5; <br /> -- -4-07- ------ <br /> Installation will serve: Residence K Apartment House 0 Commercial E] Trailer Court El Motel E] Other E] <br /> Number of I;ving units: ---/--- Number of bedrooms _YNvmber of baths _4 Lot size ---- -—------------------- <br /> Water Supp' ly., Public system Ej Community system El Private � Depth to Wafer Table <br /> , oil soil to a depth of 3 feet: Sand (—] Gravel E] Sandy Loam [] Clay Loam El Clay 0 Adobe;ff Hardpan <br /> iouApplicafion Made: Yes E] No New Construction: Yes 0 No E] <br /> 1,e tLP_re_v_`�L <br /> TYPE'OF INSTALLATION AND SPECIFICATIONS; <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> tic <br /> N -Distance from nearest well__--------------Distance from foundation______________-__- Material--____._______--____---____________.._--------_. <br /> ,o Taf— T_ <br /> No. of compartments--------------------------Size---------------------------------Liquid depth------------ ------------Capacity------------- <br /> ----------�tz <br /> �0'rdl Distance from nearest welf-----------------Distance from foundation--------------------Distance to nearest lot line----------------0q11% <br /> Number of lines-----------------------------------Length of each line------------------------------Width of'tren6-----------------------------------� <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length___._______-___-__.________.____-_______ <br /> See a e <br /> ength-----------------------:------------------ <br /> Seeye Pit: Distance to nearest well.1-0 --------Distance fro D foundation---../..i_t,.'.'---.Distance to nearest lot line------ -----1.5— <br /> ----- <br /> Number of pits.._.-/--------------Lining material-ji!?��c Size: Diameter_jall......Dept h-------A—,7.7______--- <br /> Cesspool: <br /> 77_7--------- <br /> Cesspool: Distance from nearest well-____-__---_-___Distance from foundation___________________ Lining material_-_--_____-_____._____-----__.______ <br /> ❑ <br /> aterial------------------------------------- <br /> El Size: Diameter--------------------------------------Depth------------------------------ ---------------------Liquid Capacity-------------- -------------gals. <br /> Privy: Distance from nearest well____ _ --_______._._____._.._Distance from nearest building__________________________________________ <br /> ❑ <br /> uilding-------------------------------- <br /> El Distance to nearest lot 1,111 ----------------------- --------------------------------- -------- ------- <br /> Rerriodeling and/or repairing (describe)--------- ----------------------------- ------------------------------------•-•----------- <br /> - --------------•------------ <br /> ----------- <br /> ----------------------------------- ----------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- <br /> ------------------------ -----------------------------------------I——----------------------- ----------------------------------------------------------••-------------------------------•---_--- ------------------------- <br /> I here6 t I have prepared fThn* application a 4 that the work will be done in accordance with San Joaquin County <br /> t <br /> U'a of <br /> 1 "C Joaquin <br /> ordinances, laws, an rules and. regula i s. of the, San Joaquin Local Heal'h District. <br /> (Signed)------------- A - -- ---- - --- ----- ---------- ---- ------- --- ----- --- - --------------- <br /> ------ ------- Contractor) <br /> i...... ....... .. . .... --------- (C., c ----------------- <br /> By:------------------------------------------------------------------------------ ---------- ----- -------- <br /> w e s. <br /> (Plot plan, showing size of lot, location of system in rel tion we s, buildings, a an be �ce on reverse reverse si <br /> FOR D— PAR T44ENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------------------------------ DATE----------- <br /> j A-91------------------------------ --------� ------------ <br /> REVIEWEDBY----------------------------------_ ---------------------------------------------V------------------------------- -------. DATE-------------------- <br /> --- --- ---- <br /> BUILDING PERMIT ISSUED-------------------------I-------------------------------------- ------------------------------------- DATE <br /> Alterationsand/or recommendations:-- --------- ------------------ ----------------------- -------------------------------- ----------------------------------------------- <br /> ----------------- ------------------ -------------------------------------------------------- -----------­--------------------------------------------------__------------------------------------------------------ <br /> ------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------ - --------I-----------------------------------------------------------------------------------------------­------------------------------------- <br /> -------------------------------------------------------------------------- -­­--- ----------------------------------------------------------------------------------------------------------------------------------------- <br /> Id --- 2 ; --' <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 10-52 Revised W-Mo <br />