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P APPLICATION FOR SANITATION PERMIT 7-?�e Permit No... VK, ap - ---- - -- --------- (Complete in Duplicate) i Date7lssued --- --__ -------- Applica}ion Vf- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No 49 L JOB ADDRESS AND LOCATIIPN--- Z - -- -------K,--- ---- ----- ------------------•-- ---------------------------------------------------------------- . r ------ - I Owner's Name------------- --------- --- ------ -.0------ ---------- - --------- --- ------------------- __ - Ph e--- ------------------------------ P -------- -- ----- - - - -- ----- ------- ---- ------ one_?�._ra--- --- - -------- Address-------------�_ Contractor's Name----- Installation will serve: iResicleln El'-Apartmenfj,House E] Commercial Trailer Cou� rf ❑ Motel Other E] -- Number of living units: ---- --- Nu er of bedrooms -- Number of baths _-__ Lot,size ----- :_'_O-10' 6---- ------------ Water Supply: Prublic:'System Cbrnmonity system Private E] Depth to Water'.Table ft. Character of soil to a epth of 3 feet: Sand E] Grav'el E] Sandy Loam ay Loam El Clay E] Adobe �Hardpan E] Previous Application Made Yes 01 No El New Cori truqfion: Yes e No El TYPE OF INSTALLATI-ON,IAND SPECIFICATIONS: -t available within 200 feet.) (No septic fank.or cesspool permitted if public sewer s Septic'Ta Rk!" Distance:from nearest well_________________Distance from foundation-------------------Material__-_-________--___________________________- s No. aterial----------------------------------------------- No. of Icompartments-------f------------------Size-------------------------------Liquid depth--------------------------Capacity,.,-------------------- Disposal id. isfance from nearest well_________________Distance from foundation_____- ---------Distance to nearest lot I e___________..__. .6 ? P of Numbe'r of lines--- Lpngfh each 1ine------R_-Tiive�------Width of trench_____ A ---------- Type of filter A fer"ial_* _ - wrk V. Depth of filter material--------------- Total length------11eV11------------------------- 7 $ Seepage Pit: Distance to nearest kell-40A Dist nc --Distance f fo- dafion--1 ------ oa 9 to nearest lot line/ ------------- NumbJ of p:fs--- ---Lining material' m .10 6 P I -7 Z�o ,e __a--------- 6;ek ing material Z#._S�ze: Diameter______ ---- ---_-.Depth_.__,, I I j f . 0 Cesspool: Distance from nearest well-----------------Disiance fr6m foundation_—__-"---_Lining material______-___________._________________ ❑ Siz6: Dia from --- ----Depth-!--- ---------- -------------- ------ ----- ------------ ------- ------------------Liquid Capacity-------------------------- 1� lt_� 00 Distance'from fiearest..well-------------------------------------------------______________________Distance Privy:I k - - n from building_________--___________________.----------- nea e------- -- El Distance f rest lot �inl ---------- -----------------------------------------------•---------------- --------------------- %A ,palnng (closlibe):......... -------------------------------------- Remodeling and/or repairing ------- --- -- ---------- --- -- ..........I........................---------- ------- -------- - ------- -- --- ---------- -------------------------------0, -------------------�__L--------------------------------------------------- ------------ ------------- --- ---------- --------------- 4F ----------_--__--___f_____________________________..___ ------------- ----------------------------------------------• I------ --------------------------------------------------- -------------------------------------------------------------- I hereby certify that I-lheve prepared this!application and that fhe*work will be done in accordance wiWSan Joaquin County ordinances, Sfaf it s, apd rules and'r-egyelation of the San J quin Local Health D'ffrict. J011 ------- d/oir/M J. n!ror) (Signed],---------- ...... --- TrI-c", -1 ----Owner an -----------------------------------------------------------(Title)---- 'By---------- (Plot plan, showing size of icif., loceio'n of system in'relafion to wells, buildings, etc., can be placed an reverse side). —'FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- ------ -------- ------- -------- - - ----------k�----------I----------- DATE-------- ------------Aj------ I fs REVIEWEDBY---------------------------------------------- ------------------ --------------------- -- DATt-------------- ------------------------------------ BUILDING PERMIT ISSUED.--.-&----------------------------------- ----------------- ----- -4. ---------------------------- DATE.*-----—------ Alterations and/or recommendations:---- -------- --------------------------------------- -------------------------------------------------------------------------I-------------------- ----------- ------------------------------------------------ ------------------------------I--------------------------------------------------------------------------- -------------------------------------- ----- ------------------------ ---------------1----------------- -------------------- -------- -------------------------------- --------- ------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- ------------------------ -------------- -- ----------------------------- --- ------ •---------------------------•- ----------------- ---------------------------------------------------------------------------- FINAL INSPECTION BY:.. ---------- -I!' -------- ------------------------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2 M Revised W-2100