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APPLICATION FOR SANITATION PERMIT Permit No. <br />(Complete in Duplicate) <br />This ap bate Issued ----- <br />Application-is hereby made to the San Joaquin Local Health District for a permit to const and install the work herein described. <br />_plication is made in compliance with County Ordinance No. 549. <br />� - ---'% r"og <br />JOB ADDRESS AND LO <br />CATION-v�4------.­.,e ----- - ------ -/,o �- ---- ------------------------------------------------------- <br />Owner's Name ---- 141A <br />------------ ------------------- ------- ----------------- ------------------- Phone <br />Address ---------- et, - --------- <br />------- 4�40 ---- ------------------------------------------------------------------------------ I ---------------------------------------- -----------­ ...... <br />Contracior's Name-------- <br />- <br />--------------------------------------------------------------------- ----- �­ ------------------------------------ Phone <br />.Installation will serve: Residence 0 Apartment House [:] _Commercial 1�1 Trailer Court E] Motel [:]Other <br />❑ <br />Number of living units: -------- �umber of bedrooms j - .1 <br />-------- Number of baths- --Lot size <br />------ <br />--------------------------- ------- <br />Water Supply: Public system IV Community system 0 Private E] Depth to Water Table -------- ff. <br />Character of soil to a depth of 3 feet: Sand F1 Gravel [] SandLoamA' <br />OF Clay Loam E] E] Adobe k i Clay Adobe Ll Hardpan 0 <br />Previous Application y Made: Yes El No JM New Construction: Yes � Not El FHA/VA. Yes El No El <br />TYPE .,,OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank pob1-p; <br />or'ces$'rmiff6d if -public -sewer k available within -feet.)' <br />— - I .,% <br />Septic Tank: Distance from nearest well- Z# -V -7 -'---Distance from <br />P.xAfouncafio0/4S, -------- Material- <br />" ----------------- ---------- <br />------------------- ----- No. of compartments--.L-'!W-----SizeA--­* Ca /,fir dth tyDisposal --- <br />Field: Distance from nearest , weq-k�---- Distance from founclafion--/;� - ---------- Distance to nearest lot linW <br />Number of linesleacSS --- --- <br />----------------- -------------- Width of french --- �/4p <br />Type of filter material /s <br />--- Depfh.lbf filter mafe , ---------- Total j)e,gfh-0%3r1 <br />Seepage Pit: Distance to n66 -r6 -f - �411 <br />,...)- <br />Seepage Weil--__' --- Distance.from <br />❑ Number of pits---.--------- -------- Lining material---------s-------------Size: -founclaf ion ------ -------------- Distance to nearest lot line--_-_--- -------- <br />- Diameter------------ - --------.Depth--- ------------------------------ <br />Cesspool: Distance from nearest well -__-------------Distance -from fo'unclltion ---- I --------------- Lining material------__---_- _-__------ 1 <br />y❑ <br />aterial----------------------------------- <br />0 Size; Diameter -------------------------------------- Depth ------------------------- I ------------ A --------------- Liquid Capacity---------------------------gals. <br />Privy: Distance from nearest well----' I ' <br />- <br />-------------------- 1 ----------------------- -------.__.-Distance from ne&esf building ----------------------------------------- 171— <br />F-1 Distance to nearest lot line--.--_.----_-------------------- <br />------------------- -------------------------------- --------------------------------------------------------- <br />Remodeling and /or repairing (describe):-- <br />--------------------------------------------------------------- ------ 01 -------------------------------- ---------- ------------------------------------- <br />r , <br />------------- I --------------- ----------- ---------------------------------------------------- I ------------------------------------------------------------------------------------------------------ ------------------------ <br />---------------------------------------- I ------ I ------------------------------------------------------- 1-1 ----------------------------- I ----------- 4 ----- I . �;k � <br />------------------- ------------------------------------ ------------- I ---------- -1 ---------- ----------------------------------------- -----------------------•------------------------------------------ <br />Ihee <br />reby certify that I have prepared this application and'+haf the work will be done in accordance with San Joaquin County- <br />--------------------------------------------------------------------------- <br />ordin ces, State laws, and rules and r lations of the San Joaquin Local Health Disffict. <br />(Signed) ------- <br />(Owner and/or Contract 0 <br />-------------------------------------------------------- ----------- <br />.moi <br />By: ------------ ---------------------- ------------ -------------------------------------------------------- ­� ------------------------ (Title) -------------------------------------- <br />etc., can 6e placed on rev - - - -- ------------------------- <br />(Plot plan, showing !s1Z­e`o'f lot, location of system in relation to wells, buildings; ers�`side). <br />FOR DEPARTMENT USE ONLY ----- <br />APPLICATION ACCEPTED BY ------ <br />L IAOC�,7­� ----------------------­--- ----------------------------- DAV47:- <br />REVIEWED BY ------------- 1 ---------------------------------------------------- ----------- ----------------------------- ------------------- RATE ------------------------ <br />BU I LDI NG PERMIT ISSUED----------•-------------- - ------------------------------- ----- DATE ----------- <br />---------------------------- <br />Alterations and/or recommendations: <br />------------- I --------------------------------------------------------------------------- : ------------------------------------------------------------------------------------- -------------------------- --------------- <br />-------------------------- ----------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- --------- <br />t----------- <br />----------------------------- ------------------------- ------------------------------ 1 ----------------------------------------- : ------------- --------- --------------------------------------------------------------------- <br />------------ ----------------------------------------------------------------- I ----------------- I ------------- ------------------------- -------------------------------------- ----------------------------------------------- <br />FINAL INSPECTION BY: --- - ---------------------------- Date ----- e�o'-14 <br />----------------------------------------------------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street <br />Stockton, California <br />ES -9-2M , Revised 1-57 F.P.CO. <br />300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Lodi, California Manteca, California Tracy, California <br />