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APPLICATION FOR SANITATION PERMIT Permit No. .... <br /> (Complete in Duplicate) <br /> Date Issued ------*/Tc <br /> Applica4-ion 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.' unty Ordinance No. 549. <br /> I'( <br /> 0 <br /> - - ------- --- --- - - <br /> JOB ADDRESS AND Lp,�ATPN... -3- <br /> ...... . .6 -1 ------------ _7 ----------, Phone <br /> ne-t--------- ---------------- <br /> 4 <br /> Owner's Name----------- - ------ ✓ <br /> --------- <br /> - --------------------------------------------------------------------------------- ------------ <br /> Address-----------t>z�__Z ------ ----------------I <br /> Contractor's Name------- -C I----- ------------- ------ Phone_, _ �_- <br /> -------------------------------------------- <br /> Installation will serve: Residence * Apartment House [-] Commercial El Trailer Court El Motel El Other El <br /> Number of living units- __ ___ Number of bedrooms _;?--Number of baths ---- <br /> Lot size ....._...K/-------`-----V--.9-------------------- <br /> f <br /> Waterl'Sbpply: Public-sysfam-a Comfmurify system'[]-'Private E] Depth to Water Table---6----b--'ft. <br /> 4 11 <br /> Character'o-f soil to a depth 'of 3. feet: an4 d 0 Gravel E] Sandy Loam E] Clay Loam El Clay ❑ Adobe[a Hardpan 0 <br /> Previous Application Made- Yes ❑ No [R -New Construction:--Yes-[h,;No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No Septic tank'or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest wek__NtMA__'Di,tance from fo'undafion----,/d---------.M-aferiaI---------------jaz"'6-- <br /> ------------ <br /> Nc��. of compartments--.---- -3 0, <br /> Z _Liquid clepfh----- Capacity.....�lvu----------- <br /> Dispos'al Field: Distance from nearest we'1l__AA*1e_1Disfance from foundation------. Distance to nearest lot lin p----14_...... <br /> Nu`mber of !Length of each line--------�0_ i .....Width of freinch------6Zf---------------------- <br /> Type of filter m <br /> of filter 'aferial----- f----------Total length____z5-a.1--------------------------- <br /> A_ <br /> Seepage Pit: Disfan- to-to'`­=earest:w_e11 ----'Distance from_founda'fi,n-------U'V__­____.Distancp to nearest lot line OF------ ---------- <br /> ❑ Number of,pits--------/.:__...._=--Lining.material_ "-__16_� �ize: -------------------- <br /> C pool: Distance fi4orn rest well---------------!Distance from foundation.__=______y_.___-Lining---Lining material------------------------------------- <br /> ess .nea 7 . : <br /> El Size:- Diam' eter--------I-------- - - ------- .i Depth---------:---------------------- -------------------Liquid Capacity-.--------------------------gals. <br /> PrivyDistance from near�st well-----------------------------------------------:---Distance from nearest building--------------------•--------------------- <br /> F-1 Distance to nearest�lot: <br /> ------------------------ ---------------------------------------------------------------------- <br /> Remodeling and/or ing ( <br /> air <br /> re- describe)---------- ------------ <br /> ------4------ <br /> repairing ----------I......................*......... ------------------------------------------------------------------------- <br /> -[­­ <br /> --------------------------------------- , ------------------------ ---------------------- -------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------•-------- ------------------------------------------------------------------ <br /> i <br /> --_...___'_••----..-----------------------------------------••-------------------------------- <br /> -----------7--------------------------------------------------------------•---------------------------------------------------- <br /> l.here6y certify that I haveprepaeed this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sfatrta- s, and rules and regulations of'the'SanJoaquin Local Health District. <br /> Al <br /> (Signed)------------ <br /> ...............-----------I ---------------------------------------------- -------------------------------------- ----�___Owner and/or C.onfractorl <br /> -------------------------------------------------------{Title)-10)-- - ------ ----- -------------------------------------- <br /> B Y:- -7".��. ....� <br /> (Plot plan, showing size of lot, location of system in relation to wells,'buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ------------ ---- ,---------------------------------k ----------------------- DATE----.....-n-------------------------------------------- <br /> REVIEWEDBY------------- --------------------------- -------------------- :---------------------------------------------- DATE------------------------------------*----- ----------------- <br /> BUILDING PERMIT ISSUED-------- ----------------------------------------------------------- DATE-------------------��/---------------------------------- <br /> ------------ ---- <br /> Alterations and/or.recom mienda-tions------------------------;7---M-----------------------------------------------------------;-_1............................N__�----------------------------- - <br /> ------------------------------ --- --- ------- ------N-�.............I-,------------------ <br /> .......................I-------------------- Z--------------1-........ <br /> -eq-4­��-- ------- -------------------------------------------------- <br /> ------------------------ <br /> ---------------- -------- -------- ----- --- ------- <br /> --------------------------------------------------------------------------------- <br /> ---------- ------ --------- --------------------------------------------------------------7-------------------/------------------------- <br /> -------------- ---- -------------------------------------------------------------------------------------------- ------------------------------ ------------------- ------------------------- ------------------- <br /> FINAL INSPECTION -13Y:- _ -- - --- <br /> ------ <br /> ----- ---- ---- ---------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycern*re Street 814 Norfh "C" Street <br /> Stockton, California Lodi, Calif*rnia Manteca, California Tracy, California <br /> ES-9-2M Revised W-2100 <br />