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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Applica-1-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrNed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> ,�,TION.. -_------------ <br /> JOB ADDRESS AD LOC <br /> Owner's Name- _do �­d_Arff---------- hone_-.. <br /> ---------------- -- - -- ---------- ------------------------------------------------------------------- <br /> Contractor's Name-------------------- --------- ------------------------------------------------------------------------------------- Phone <br /> -F..4— -------- ----- <br /> Installation will serve: Residence [E—] Apa <br /> tment House F] Commercial. E] Trailer Court F] Mot [j Other <br /> Number of living unit' Number of bedroomv-7- Number of baths _`�---- Lot size ------a. -dK............... <br /> Water Supply: Public system El Community system El Private),� Depth to Water Table --- --- <br /> N <br /> -- -------------- --- <br /> ------ ------- - ----- --- <br /> F, -A,-a trnen_t__H`ou`s,__�----Commercial. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] tay kAdobe E] Hardpan <br /> Previous Application Made: Yes El No K New Construction: Ye.s 0 NOA <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> _ ____I <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------ ----------- <br /> F1 No. of compartments-----------------------.--Size--------------------------------Liquid depth--------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation------------------ Distance to nearest lot line----------------- <br /> El Number of lines-----------------------------------Length of each line-------A---------------------Width of french----------------------------------- <br /> Type ;—filter material-------------------------Depth of filter material-----------------------Total length_-__.______________.____________________-- w <br /> S <br /> ength----------------------------------------- <br /> Se'# 1%. <br /> e0PAO: Di ante to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-__._._________ <br /> of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth <br /> /I/ ---------------- <br /> 5C;esspool: 3-1'Distance from foundaf ion----- - -----------e <br /> Cesspool: Distance from nearest well--_ Lining material...1 <br /> Size: Diameter----------1-0-e-----------------Depth----------------- -------------------------------Liquid Capacity-.__,.SrC2A0_&...gals. <br /> Privy: Distance from nearest well______ -------------7---------------------------Distance from —nearest buNding-------—------------------------------❑ - <br /> Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- <br /> R medelin an or re alrin (describe) - -------- <br /> ---------- -- -- ------------ ------------------------ 7----- ------- ------ - ------------- ---- --- -- ----- <br /> ----- ------- ----------------------- <br /> I hereby ce y that I have epared this application and that the work will b done--irt-alrd-ance with San- Joaquin County <br /> ordinapces, St t law d rules/and reaulatio bf f e San Joaquin LocVTbalth Distrie. <br /> ---- ------- - -- -- - ------------------------------- ----- ----- --- --------------(Owner and/or Contractor) <br /> 4_0 <br /> By:.- -1 ­_A­�'. agii;ic„ -----------------------(Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relafgh to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------------------------------------- --------- DATE------------------------------------------ -------- <br /> REVIEWED BY------------------------------------------------------------- ------ - ---- --------- DATE---- <br /> - --------- - ------- t!�-(---------------------------------------- <br /> BUILDING PERMIT ISSUED------------ ------ ---- ------- DATE----- ------- <br /> Alterations and/or recommendations:--------------- ----- ...... ----------------------------------------------------------------------------------------------------------- <br /> ----------- --------I----------- ------------------------ -------- ----------------­---------------_­ -------------- -------------------------- <br /> ---------- <br /> �4A...... -- ----6�� ee _7 <br /> - ------------------------------ --- ------------------ n ------ ------- ----------- -------------- ...... -1- - -------------- <br /> ----------- ------------- - --------- --- <br /> -- --------- - ----- <br /> -- ----- ---- <br /> - - ------ . ...................... -- -------------- -- ------------ -- --------------------------- <br /> FINAL INSPECTION BY--------- ------ Date----------- <br /> _olOw--------------------- ---- - <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 Revised W-2100 <br />