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Permit Noz;;Z, <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) 0, <br /> -7 Date Issued <br /> 7- <br /> Application is hereby made to theMaoaquin Local Health District for apermit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinan o. 549. <br /> ---------------_ - - ----------------- <br /> JOB ADDRESS AND LOCATION---------- ----4---W_ ,�t------ -- -- --------,r <br /> - ------ ---- ------ <br /> Owner's Name----------G��t-----W_�­� --- - --- ------ ------------------------------------------------------- Phone-/4 <br /> Address_-------------------- t4 <br /> I_q Vz <br /> ----f4-77 � ..........--------------­­­---------­--------------------------------------------------- <br /> Contractor's Name,-% _k IS! < <br /> ------ ---- ------------------------- Phone-- <br /> Installation will serve: Residence Apartment House El Commercial E] Trailer Court Ej Motel [] Other ❑ <br /> Number of living units: d)1k.Number of bedrooms _Z__ Number of bafhs6l��_ ot size ---�7­5__X_/---7MF-5------------------------- <br /> Wafer Supply: Public system [-] Community system J-1 Private W Depth to Wafer Table &ly- ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam [] Clay Loam [:] Clay 0 Adobe Hardpan F] <br /> Previous Application Made: Yes [-] No 9 New Construction: Yes F1 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) NNK <br /> Septic Tank: Distance from nearest well Distance from foundation--- ---- Materlal----- - ------- <br /> No. of compartments---- ---------Size_S6_!_S/0___ZDs_Liquid clepth._,.,,�_2------------------6apaci;y____A� <br /> Disposal Field: Distance from nearest we1i__X,1_.`_.__Distance from foundation--,.17-A-I------Distance to nearest lot line—A10-1.... <br /> Number of lines___ -------------Length of each line-Zille- ----Width of trench_A/ J* <br /> air 74 <br /> ................... <br /> Type of filter material_//$/A__64/[---Depth of filter material--- ----- -----Total length____,..?0--------------------------- <br /> Seepage Pit: Distance to nearest well---//a-,------Distance from foundation---;w'5 -----Disfance to nearest lot ling-- ------- <br /> xNumber of pits___07PIA-------Lining maferial__E9_1Z_X---Size: Dlannefer__.3W_"-------Depth---so---1�------------ <br /> Cesspool: Distance from nearest well_________________Distance from foundation_____-_____________ Lining material-------------------------------------- <br /> El Size: Manneter--------------------------__--------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----- -------- --------------------------------Distance from nearest bullcling------------------------------------------ <br /> ElDistance to nearest lot line------ ------- ----------------------------------------------------- --- -------------------------------- <br /> Remodeling and/or repairing (clescribe):_ ---- -- -- - --------- -- --------- ... <br /> ------------------------------------------------------------ -------------- — ------- --------------- <br /> - - <br /> ------------------------------ - ------------------------------------------------------------------------ ------- <br /> -- --- ----------•---------------------------------------------------------.-"---- <br /> -------------------------------------------------------------------------------- <br /> - __a_ <br /> ------------------------- <br /> I hereby certify that I have p ared this application an that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat la. s, a rules the ol e San Joaquin Local Health District. <br /> /.Pd <br /> (Signed)------ -- -- --------- -- - ---- ---- -- - - ------- -- -- --- ------ --- _______(Owner Od/ Contractor) <br /> fA <br /> /or <br /> By:-------------- - - - -- - ----------------------------------(Title)---- ----------------- <br /> IC4 <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pie on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -3- <br /> APPLICATION ACCEPTED 13Y- ----- -------------------------- ---------- ----------------------------------------------- DATE <br /> REVIEWED BY -- DATE-,-— <br /> N�g----------------------------------------------- <br /> BUILDING --- <br /> ------------------------ <br /> PERMITISSUED---------------------------------------------------------------------------------------------------- DATE--------- <br /> Alterations and/or recommendations:-------------- --------------------------------------------------------------------------------------------- <br /> ------------------------------- <br /> ---------------I---------------------------------- -------------------------------J­_.J-.-�--------- --------------------------------------------------------­---------------------------------------------- <br /> -----------I--------11�----- _. - - ------- <br /> - --- -- ---- -- ------ ---------------------------------------------I------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------ -------------------- <br /> -- --------------------------------------------------------------------------------------------- <br /> --------------------------------------------- ----------- --------------------L--------------------------------------------------------------------------------- ---- -------------I------------ -----------------I-------- <br /> -- <br /> FINAL INSPECTION BY: ------------------------------------- <br /> ---------- -- or -7 17 <br /> Date_. Aj --------------------------- <br /> ---------- <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 8-51 Revised W-2100 <br />