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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) /_I/Wsz-- <br /> Date Issued ---- <br /> Applica}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 with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------I-_--`-_(_4-,------- .----- . -- ----•..7!7------------ --------------- <br /> Owner's Name---- ---------f3&jUAA------------------------------- ---- ---------------------- ---------------- Phone----------------------------------- <br /> Address------------------------------------ ...........9-r,...... <br /> -------------------------------------------------­------------------------------------------ -----------------;Z <br /> Contractor's Name-- 'jn..VLLCI_CIA--------S_7i; 7�3!� 1 <br /> _T------------------------------------------------1----------­­ P ---------------I........6 <br /> Installation will serve: Residence Ull-<Partment House Ej Commercial [] Trailer Court E] Motel [-] Other E] <br /> Number of living units. Number of bedrooms .-/-. Number of baths ___t_ Lot size -------tS_7716---/--- --- ---- <br /> Water Supply: Public system [R�'�ornmunity system [I Private 171 Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam F] Clay Loam E] Clay C] Adobe B- HardpanE] <br /> Previous Application Made: Yes E] No E§-"N_ew Construction-. Yes [-] 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 well._AAT�._ _Distance,from fougda tion___r_0---------Material---------------------------- <br /> No, of comparfments_.Z__�...........Size....-15-7- ---- ---- iquid clepth----- -.'_(___Ca pacity.. .. <br /> Disposal Field: Distance from nearest well. W-U-Distance4from foundation___r_q--...____.Distance to nearest lot line--- <br /> Number of lines------I---------- ------ ----Length of each line------i-� _______.Width of trench.__..__A�_Vft_______-_____-__ <br /> ,----------y <br /> or Depth of filter material---Le.............Total length___.__ -------- <br /> Type T filter maferial__:!4_ t--- __ <br /> Seepage Pit: Distance to nearest Well-l't ----Distanc4­fpm foundation--- 74 <br /> 74-.-..Distance to nearest lot'liD.Q------5 <br /> Eijl� Number of pits...._________________Lining material_- .__.Size: Diameter_____..'_..___.Depfh----.?---1----*--------------- <br /> Cesspool: Distance from nearest weil-------- ---- ---Distance from foundation--------------------Lining material__..__________._._.________---_..... <br /> El Size: Diameter-------------------------- -----------Depth----------------------------------------------------Liquid Capacity_-------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------- ---------Distance from nearest building.__._._.______________________.__..___.._. <br /> 0 <br /> uilding----- ----------------------------------- <br /> 0 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------- ----------------------------------------- <br /> ---------------------------- -------------------------- -----------------------------------------------------------------------------------------------------------------------------I-----I...I.... ----------------------­ <br /> -------------------------I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------I---------------------------I--------...I-----------------------------------------I----------------------------------•--------------••--------•-----•-----------------hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sflt&laws, and rul IJAAldtV&ts. of the San Joaquin Local Health District. <br /> ... ,OSeptic Tank Service Contractor <br /> (Signed)------ Six iWoradw---HO-2-7046--------- -------- --- ---- <br /> ------------------sw_ ---- ------ -i-------- ----P-0------ C <br /> By: .. ---- -- --- ----:_{Title)----- --- -------------------------------------- <br /> ----------------------------------- ---L" . <br /> (Plot plan, showing size of lot, location of system in relation to w Is, buildings, et ., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------- --- -- --- - -- ------ ------------------------------------------------- DATE-------------�,e_i <br /> REVIEWEDBY-------------------------------------- --------------- -- --- --------------------------------------------- DATE-------- r - r '.. <br /> BUILDING <br /> ATE--------- <br /> BUILDINGPERMIT ISSUED------------- -------------- - -------------------------------------------------------------------- DATE--------------------------•---------- --------------------- <br /> Alterationsand/or recommendations:--------------------- ------------ ----------- ------------------------------------------------------------------------------------ -------------------------- <br /> ------------------------ -J�7 j---- -------- ---------- ------ <br /> ----------------------- -- ......T -- -------------------------------------------------------------------------------------------------------------------- <br /> ------------------------ -- ------------------------------------------ ----------------------------------------------- ---------------------------------------------------------------------------------- <br /> ---------------------------- -- ------- -- ------- --------------- ----- ----------- ---------------I------------------------------------------------------------------------------------------------------------ <br /> 0 <br /> FINAL INSPECTION BY:----- -------------_------------- Date.------------------------------------------- <br /> SAN <br /> ate--------------------------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street M Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES---9-2M 145446 ATWGUn 12-54 <br />