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APPLICATION FOR SANITATION PERMIT Permit No. ................. <br /> (Complete in Duplicate] Date Issued V, <br /> Application <br /> is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION 4------------------------------------------------------------- <br /> ------- ---------- , f Z­ <br /> Owner's Name-----------------------------------------G-_6,EG_oP------witeila... ------------------------------------------- Phone--------! `,�--------------------- <br /> Address------------------------------------------------------3At---,w--------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name----------------------------- PARP.1-sh-------I tM------------------------------------------------------------------- Phone... <br /> will serve- Residence 04 Apartment House [-] Commercial [:] Trailer Court [j Motel E] Other E] <br /> Number of living units: Number of bedrooms Number of baths /--- Lot size ._,8xr_0'_X----6_0-—------------- --- al <br /> - <br /> Water Supply: Public system 0 Community system El Private X Depth to Water Table -------- ft.. <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel E] Sandy Loam E] Clay Loam E] Clay r-1 Adobe Hardpan-t!]-� <br /> Previous Application Made: Yes E] No X New Construction: Yes X No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pubic sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well --Distance from foundaflon-10----------- <br /> ---..--- <br /> ------------------No. of compartments...2-------------------Size,.:r4K!!__?0ea_foundation__ <br /> 'd ...........Capacity---- _?t_ <br /> .IjUL <br /> ]K F Seo, -I_4T <br /> Disposal Field: Distance from nearest well-9-0---------Distance from founclatiok- --__.Distance to nearest lot line- <br /> Number of lines---..I------- -- -- ---------------Length of each line.----_ --'...........Width of french.__2_j. ._'0------------------ <br /> Type of filter materialJIVIRk------Depth of filter material-_ 114?:�-----------Total length-71-------------------------------- <br /> Seepage Pit: Distance to nearest well --________Distance from foundation-------------------.Distance to nearest lot line--..---------___ <br /> El Number of pits----------------------Lining material---------------------..Size: Diameter-----------------------Depth--------- --------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----- --------------Lining material------------------------------------ <br /> El Size: Diameter----------------------------- - ------Depth------------------------------------------ --------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---❑ ------------------------------------------ <br /> Distanceto nearest lot line------------------------------------------------------------------------------------- ---------------- ------------------------- -------- <br /> Remodeling and/or repairing (describe)----------------------------------------------------------------------------------------------------------------------------------- --------------------- <br /> -------- ­­---------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------- -------------------------------------- ------------------------------------------------------------------�­---------------I------------------------------------------------------------------------ <br /> ---------------------------- --------- -------------- ......I---------- ----------------------------------------------------------------------------------------------------------------- <br /> I hereby c ify that I h pre ed this application and that the work ill lane in accordance with San Joaquin County <br /> o k I e i <br /> Local 'e <br /> w tnr <br /> ordinances, Sfa e I s, and r es an egulations of;+hoa Joaquuu� Local ie Dir, cf. <br /> (Signed]---------- ---------------- -------?=---- -- ----- ---- ---------- -- - aw Contractor] <br /> By:..........--------------------------------------- --------------------- ---- --- ------- --------- ----- -- -------(Title)...&Aili MAIO AL- ------- -------- <br /> (Plot plan, showing size of lot, location of system in, re tion to wells, buildings, e can be placed on reverse-side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_��----- DAT -----------------------I---------- --------------------- <br /> REVIEWED BY--------------------------------<_ _N DATIE___-��--_ ------------------------------------ <br /> - i�i -) �---- --------------------------------------- --------------- _1ZN------I----11 <br /> BUILDING PERMIT ISSUED------------------------------------------- ---------------------------------------------------------- DATE--------V-------------- --- -- <br /> Alterationsand/or recommendations:----------------------------- --------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .......................................... <br /> ----------I--------------------------------I------------­------------I------------------------------------------------------------------------------- ---- ---------------•-•- -•------------------------ ------------------------------------------------------------------------ -------- -----------------------------------------­------------------------------------------------------------ <br /> ---------------------------------- ----- - - --------------- ----------------------------------------- ------------------------------------------ ------------- ------------ ------------------------------- <br /> ---------------------- --------------------------------------------- <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-2100 <br />