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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) ,-v/ <br /> A <br /> T�plication.is hereby imade to the San Joaquin Local Health Dist ripermit to construct and install f <br /> Date Issued <br /> application is made in compliance with County Ordinance N cf for a <br /> he work herein described. <br /> JOB ADDRESS AND LOCATION <br /> ----- - -------------5; <br /> 4--------------------------------------------------- <br /> Owners Name-- <br /> C ---------- Phone <br /> --------------------------------------- <br /> -------------- --- ------ <br /> Addre! <br /> - ------------------------ Phone_ <br /> ----- <br /> ------------- ----- -----------------------------------------------I-------------------------- -------------- <br /> Contractor's Name---------- -------- --------- <br /> ------------------------- <br /> Installation will serve:,Res Ven Bence I Apartment House Co ---------------------- <br /> Commercial ❑El Trailer Court ❑E] .Motel <br /> N units:Number of living n!tj:',-. bedrooms Number of baths E] Other E] <br /> Number Of <br /> Wafer Supply: Public system [j 'I.- -Z--- Lot size 4�1--------------- <br /> Commun'* system E] Privat Depth to Wafer Table <br /> Character of soil to a depth of 3 feet: ff. <br /> Previous Applicafion Made: �Yes Sand 0 Gravel E] Sandy Loam E:] Clay Loam 11 Clay El Adob Hardpan <br /> El.,t�N ❑ <br /> �q� New C,risfruction: Y <br /> No E] <br /> TYPE OF INSTALLATION AND 'SPECIFICATIONS: ej4 <br /> (No septic tank or Cesspool pe7rmiffed if public sewer is available within 200 feet.) <br /> Septic Tank: Disfanc7e�from rieaEes. ell------ Distance from foundation <br /> No. of compartments-fk --------- .-_________________Materia!_.____._____ <br /> ------- <br /> .--------------jJ......Size ------------------- -------------------- <br /> --------------------------------Liquid depth---------------- --------Capacity------------ <br /> _ p --- Na <br /> Disosal F' Ix k ID' % <br /> isfa'nce'ft-om nearest well <br /> 7 IR j__...,_.D;sfance from foundation <br /> '//A/y . Numb%lo..l lines---------------------- t Length of each line----------- -----------Distance to nearest lot line-----------------Nk' <br /> 0 <br /> _QTyPe ' T filter material-------------- -----------Width of trench.------------------------- <br /> ----Depth of filte rial- -------- <br /> Seepage, Distance to nearest well.- sf In ' Tom fou ati n ........Total length-------------- ----------------- <br /> Nf: <br /> Number /-�9q'-------Di7 -- -- ------------Distance to nearest lot line <br /> of pits------/--------------Lin�in` m f 'ta <br /> I - - -- ------ -Diamefer__:,?---I__------..Depth--- <br /> Cesspool: -------------- <br /> Distance from nearest well__.____I_ ----- ........ <br /> X!5r <br /> 10E] Distance from n ati n----- -- -----------Lining material-------- <br /> k,, Sr'Slze. Diameter -4 1 1 ., <br /> ----------- ------- ---------- --------------------------------Liquid Capacity_ <br /> Privy: Dist Distance from nearest wel) ------------------------gals. <br /> n <br /> [] i f e_ -------- <br /> �' a n, i ----­­------------------------------Distance from--nearestbuilding----- -------- <br /> Disfa nce�fo,nearest lot line----- 11 t I <br /> ----------- ------ ---------------------------------- I------------- <br /> r t <br /> Remodeling ----------------------------------------- ---------------- <br /> 5`6d/ori 'pairing (describe]:---_-__---�n <br /> -------------- ------ ------- <br /> ---------------­-------- -------- ------------ --------------------------- <br /> IS% ------------------- <br /> ------------ --------------- -------- -------------------------- -- ---•--------------•-=-----------------I --------------------------------- ------- <br /> ­------------------------ -------:��. ; 1k <br /> %.4, ------------------------------------------------------- -------- <br /> --------------------------- --------------z----------- ----------- <br /> ------------------------------------------------------------- <br /> *1 <br /> ------------------------------------- ---------------------------- ----------------------- <br /> --------- --------------------- .1 <br /> prepared this aPPli�t�a�ion and that fh"-' k will be done in accordance with San Joaquin County <br /> I hereby certify that I have pre� -------------- e wor <br /> rubs . re ul vionslo <br /> ordinances, Sfate-l6ws, and rwlps and, f 66 'San Joaquin� Local Health District. <br /> (Signed)---- <br /> ----------- <br /> --------------- <br /> ---------------------------- ----------- (OwnerSq�nd, r%Confractor) <br /> By:-------- <br /> ---------------- --------- ..... ------ <br /> 1-49---------------/ <br /> T" <br /> A--------- ------------------------------------------(Title, <br /> _ j <br /> (Plot plan. showing�'size of lotAocaflon of system in re <br /> lafion fo wells, buildings, etc., can be p ----. <br /> ed on rave side)- -- - --------------- <br /> 1`611 D PARTMENT USE ONLY <br /> t <br /> APPLICATION ACCEPTED BY <br /> REVIEWED BY---. I ... ................ -------r------ --- ----- - -------- --------- <br /> DATE_.__J� <br /> ................. -------- DATE_-_:-------- ------------ <br /> ....... -------------- -- --------- I I------------------- <br /> " , ----------- ------------------------------ --------- <br /> BUILDING PERMIT,"ISSUED --------- <br /> - 1-�-.--, I *- ------------------------- ------------- <br /> Alterations <br /> -------------------------- <br /> -- I----------------------------------------- :!" -------------------------- <br /> ___ <br /> Alterations and/or recommend&­fio'n�s:_._'!=- - J ---------�ATTE• <br /> - ---------------------------------I <br /> ---­------------------------------------------------------------------:--------------------------------­-------------------------------------------- ------- <br /> -------------------------------------------*------- -------------------- ---------------- -------------------------------------------------------------------------------------*-------- <br /> -------------------------------------- ------ <br /> ------------------------------------------- - -------------------------------------------------------------------*-------------*--------------*------ A--- <br /> ------------------­--------t--- ----------------------------- ------ -------------------------------------- <br /> -------------I ---------------------------------------------!------------------------------------------ -------- -------------------------------------------------/-N------------------- <br /> ----------------------------------------------------------- ------------------------ <br /> FINAL INSPECTION By % <br /> ---------- V- 4 11 5 <br /> [)at _7'�C <br /> Date-- -----------i_e___ --------------------- ------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Sojih Amer'\n S+reef 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> -1 St.ckfon:*California '1% Lodi, California <br /> .' .1 Manteca, California Tracy, California <br /> ES-9-2M 10-5.2 Revised W-2100 <br />