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APPLICATION FOR SANITATION PER P <br /> (Complef ermit ,No. <br /> a in Dupl;cafe) ........ <br /> Date Issued <br /> 457-9 <br /> Application is hereby made to the San Joaquin Local Health District for a pormif to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance o. 549. <br /> S AND LOCATION.' <br /> JOB ADDRESS <br /> Owner's Name &I-- ----- <br /> ...... -------- <br /> • <br /> ------------------- --------------- <br /> Address.... - ---------- ------ ---------------------------------- <br /> .......... ------- ------ --- <br /> ------------------------------------- ----------------------------- <br /> Contractor's Name.__-__._. -_---------------------- ------------ <br /> ----�ce ---- ------ ­---------------- 7__ _1--------------- ---------------------- ............. <br /> Installation will serve: Residence AparfrrienflHouse L3 phone '?-------- <br /> Number of living units: Number of bedrooms Commercial 0 Trailer Court [] motel 0 Other ❑ ------------ <br /> Wafer Supply: Public system -et- ❑ <br /> Number of baths _L. Lot ❑size <br /> fl�l�commu <br /> Character of soil to a nify"Sysfe�n El Frivlf- 0 Depth to Wafer Table _g4 <br /> , &_ ff. iF <br /> depth of 3 feet: Sand El i Gravel E] Sandy Loam'Ej, Clay Lo&n E:] Clay 0 Adobe 2TO"Hardpan <br /> Previous Application Made: <br /> Yes ED No R_*'�N'6w Construct'on- Yes N <br /> C <br /> TYPE OF INSTALLATION AND SPE-CIFICAT16 'S: <br /> {Na <br /> 0 Se0fic tank or Cesspool permitted if <br /> public sewer is available vhjith <br /> Septic T nk, Distance from nearest n 0 feet <br /> m foundation"----"No- of compartments----------well------------------Distance 'fro , <br /> ............. MaferiaJ--. <br /> Size, ---------- <br /> Disposal Field: _.—---------------------- ---Liquid cl�Pfh ------------------------------- <br /> Disfance-from nearest well."-: _- , ' ----- -------------Cap6cify-------- ----- <br /> El Number or .-Disfance from foundation t, --------------- <br /> I fines-----------------------------------Length of each line------------------------------Width- ----------------------Nfance to nearest,lot I;ne------------ <br /> TYPe or filter mate'rial--------------------- <br /> Se if: ' ' I �h ...Depth of f1j..fier.- feria) of french-------- ......... <br /> Distance to nearest w -----------------------Total length-------•---- <br /> t --------- <br /> --------------- <br /> ---Dist r u� ----- <br /> OP� Number of pits 71------- �e_f un ion---- <br /> Cesspool: ------------------Lining mat ..-..Distance to nearest lot line <br /> jal-_ <br /> . ... .. Siz Diameter %3 - ------- <br /> from <br /> t ------- -----------Depth <br /> Distance from nearest well----------------Dist e from ------ <br /> EJe/A:v2Z� Size: Diameter------------------------------------.--Depth-. af;on------------------ - --------------- <br /> Privy: r ----------------- - Lining material-------------------------------------- <br /> Disfance from nearest well-------------- -------------- ---------------------------------Liquid- Cv'acify_,_-.-----------------------gals.- . <br /> El Distance to nearest lot line------- -------------Distance fron"nearest building---------------------I <br /> :----- <br /> Remodeling <br /> ----Remodeling and/,, repairing (describe):..----- 1� --------- ----------- -------------------- <br /> ------------------ ......... <br /> --------------------- <br /> - ------------_--------------------------------------------------- ------- ------------------------------ -- <br /> -•-- <br /> ----•- <br /> --------------------- :------- -1 -­__�------------------------------------------ ------------------- <br /> t -------1------------------------------------------- ------------ ------------------------------------------------------­­---------------------------- <br /> ----------------------------------------------- _71. --------------- ------------------- <br /> ---------------------------------------- <br /> I hereby certify that ------------11---------------------------------------- ----------------------------------- <br /> --- ------ -- -------- -- ----- ------- ----- --- - --- - <br /> ordinances. f I have prepared This applicafio�"a"n' d that fhe" war-k.will__b-e__done__in__accordance- - __with-h Sa-n---Joaquin- - - - C,o-unf.y <br /> State laws d les and regulations & S, <br /> ru <br /> of the an Joaquin LocalL Health District, <br /> {Signed) <br /> y:---------------------- <br /> ------- ---I --------- <br /> I-ID ----- .- ------ ---------- -------------- <br /> B �---- -------------- ------------------------------------------- <br /> =r—and o <br /> ---- -------------------:------------ & . r Contractor) <br /> an showing size of tot, -------- ... ----- <br /> -----(Title)--- <br /> P <br /> ---- d <br /> (Plo+ PI <br /> location, Of system in r" -----(Title)--- <br /> e af ion to wells, <Z--.= <br /> �_ ,---- --------- ------ <br /> cli ��- ----- <br /> L <br /> side):re <br /> buildings, <br /> etc., a�on�� <br /> 0 LY <br /> bu�� <br /> T ---------------- <br /> buildings, efc., can be Placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION <br /> ACCEPTED BY <br /> ----------- <br /> REVIEWED By ----------------- -------- <br /> ---------------------------- --------------------L------------ ------- <br /> , - I , V ------------- ATE- <br /> ----------- D <br /> ----------------------------------------: _;�' ___1------ ----- <br /> DA ---------------------------- <br /> BUILDING PERMIT ISSUED------"-"-- ----------------- TE'--'.- - <br /> -------------- --------------- <br /> --------------------- --------------------------- <br /> Alterations and/or.recommendations':--------- - -- ------------------------------ DATE <br /> ---------------------- ---------- ----­_�---------- I � ------- <br /> -------------------------------------------------------------------- ------------------- _77-1-1------------ <br /> -------------------------t-------------- ------------------------------ <br /> ------------------------------------------------------- ----------------------- --------------------------------------------------------------------------------------- ------------------- <br /> ------------------------------------------------------------------------------------------------------I----------------------------------------------------------- ----------------------------------------- ---------------------------------- <br /> ----------- <br /> ------------------------- ------------------------------------- i---------------- -------------------------------------------------------------------------------- -- <br /> ------------------------------------------------------- -------------------------- -----"----•--------;- ------ <br /> FfNAL- <br /> ------------------;---------- <br /> FfNAL- INSPECTION BY:___--"--- .. .. I -------------------------------------*-------- <br /> --- -- --- --------------------------------- d - <br /> Date--- 11,,� , <br /> ---------------- <br /> ------------------------- <br /> '30 South American Street SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak street <br /> Sfockion, Cal;forAia 132 Sycamore Street <br /> Lodi, California Mbhfei:a- California 814 North -C- street <br /> M r0-52 Revised W 2100 <br /> Tracy. California <br />