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APPLICATION FOR SANITATION PERMIT Pernr't No.�4�...- ` ..,._`. <br /> L (Complete in Duplicate) <br /> Date Issued <br /> Applica-%n 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 Or finance No. 549. <br /> JOB ADDRESS AND LOC TION-- -- (C�- - ----- --- ---------�i_20------------- ------•--�-1 <br /> Owner's Name------------ <br /> Address <br /> ---------- �....__ �-C.c�-G 1 ho <br /> ' - P `_afs <br /> rt= ---------�S <br /> Add ress------------------------------- G` <br /> Contractor's Name------------- -------Lr .c----------------------------------------•---------•-----------•------ Phone__ ./.6__!_. ?. <br /> Installation will serve: Residence CK Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other ❑ <br /> Number of living units: J---- Number of bedrooms 2---. Number of baths __!____ Lot size __; 's_ __ __._. _ }?U--___-.____ <br /> Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table4zoft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)( Hardpan ❑ <br /> Previous Application Made: Yes No ❑ New Construction: Yes ❑ No ❑dz ey- j�_11 F��p -, a"' '7 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: -fy 5 <br /> V__ <br /> (No septic tank or cesspool permitted if pu c sewer is available within 200 feet.) <br /> �Distanc from foundation__ __ <br /> Se tic ank: Distance from nearest ell_ � ____ .__.Material___ _ (�---_. <br /> No, of compartments A. Size_ -- - -- __-Liquid de th_��.�� _ _ Capacity-t-�__.. - <br /> C(' P -- q p ----- j <br /> -- <br /> p �w7 { ____.___.Distance to nearest lot <br /> Dis osaI i . ' Distance from nearest well__ _.r --._Distance from fours ation_____ <br /> Number of lines________I_____ _____r._ ___ __Length of each line----3_,.�_---______.Width of trench---- V:�................ W <br /> Type of filter material__A ]._`�. _i___Depth of filter material__/9__________._Total length_ _. _______________________________ <br /> g -_._ 0-s .__.Distance to nearest lot line___ Q <br /> See a e Pit: Distance to nearest welL.�_d_�._ _ Distance from foundation__ <br /> Number of pits___.______________Lining material�i� . ___-� ______5ize: Diameter_.s - - -�-----Deptn___ e___ ________________ <br /> r <br /> Cesspool: Distance from nearest well---------------__Distance from foundation_________.------.--.Lining material--------.----------------------------- <br /> El <br /> ____.- --------_-.-________.❑ Size: Diameter----- ---'--------------------- -------Depth----------------------------------------------------Liquid Capacity----------------------------gals. 0 <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_______________________.____._____._. <br /> ❑ Distance to nearest lot line------- ------------------------------------------------------------------- <br /> Remod ling and/or repai irlg (descr'sbe):�- __ __ ___`4-.--- _-- __ _____ ------ <br /> -T. _ .. <br /> ------------------------------------------------------------------ ---------------•---------------- -------------------- ------------•--------------- --•-'f----- <br /> -------------------------------------1----------------------------------------------------------------------------------------------------------------­---------------------------------------------------I---------------- <br /> I <br /> ------------- ----------1-------------•-------•-------------------------------------------------------------------------------•-----------•-------------------------••----------------------------------------- <br /> I hereby certify that I have prepared his application and tha+,the work will be done in accordance with San Joaquin County <br /> ordinance�,`sr-5tafe iaw'f;and rules ad reg�iltations of'fhe San Joaquin Local Health District. <br /> • <br /> (Signed) { "Contrac+orl <br /> By-------------------------------------------------------.-..---------------------------- _-- -j'r-'�------- Title)------ 0� `- ------------ <br /> (Plot plan, showing size of tot, location of system in relation to wets, buildings, etc., cap be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BY-------------- ------------ ---- -------------------f-f_,S_-{3--.------------------------------ DATE------ ----•-.. .... . <br /> REVIEWEDBY-------------=------- -- - --------------------------------------------------------------------------• DATE <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------- <br /> Alterationsand/or recommendations:-----------------------------__----------------•-----------------------------------------------------•--------------•----------------------------------- <br /> ---------------------------••-----------------------•------•-----I——------------------------------ ----•--------------------------------------------------------•--•---..-----------•-----_--------------•------------------ <br /> ---------------------------------------------------•-----------------•----------------- ------------ ----------------...---------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------.--------- <br /> ---------------------------------------------- ------ ----------- --------------------------------•-----•--------------------•---------------------------------------------------- ------------------------------ <br /> . <br /> F]NAL INSPECTION BY:------- <br /> ---------------------------- Date------>---------------------------------------------- <br /> SAN <br /> -------- ----- <br /> --------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M . Revised W-2100 <br />