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APPLICATION FOR SANITATION PERMIT Permit No. ------------_/- <br /> (Complete in Duplicate) Date lssued,1:75:n5�3 <br /> Application 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/!J compliance with County Ordinance No. 549. <br /> ? TV VV <br /> JOB ADDRESS AND LO -ATIC�N <br /> . ..........._---- --- <br /> f, <br /> ......................... <br /> Owner's Name-_-----Cy �oj--_-_-------------•------ - ---------------- .... <br /> - <br /> Address------------------_----- ------ ­11r10--------­---------------- <br /> ---------------------------------------- <br /> -Ae Phone <br /> --------- Y2 ----------- <br /> Contractor's Name--------------------------4 <br /> - --------_---------___-------­------------------ <br /> Installation will serve: Residence Ap ment House E] ,, Commercial.E]; .Trailer Court F <br /> Motel <br /> - <br /> Number of living units: Number of bedrooms Number of baths Lot si;.6112F <br /> Community system F te0k Depth to Water TabI f� <br /> Water Supply: Public system F1 Priva <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay E] AdobeR Hardpan 0 <br /> Previous Application Made:..Yes E] No ' New Construction: Yes El No <br /> TYPE OF INSTALLATION AND SPE(No <br /> - <br /> (No sepFic tank or cesspool permitted if public sewer.is available within 200 feet.) CIS <br /> Septi Distance' from nearest we:l.................Distance from foundation-_-_....... Material__.-..__...._..___-_______------.--_.--_.--.-_. <br /> ----------------_-------Capacity-------------_----_-- <br /> No. of comparfments..........................Size-.-_._--__.____. ..........Liquid depth <br /> Septi <br /> 6D sposal F' Distance' from nearest well...3,00."Distance from founclafion..4_40-.__Distance to nearest lot <br /> --------------Length o -------Width of trench_._._..____--- <br /> Number of lines.............. f each line.-42 <br /> Type of filter of filter material..... b . ... <br /> __.._.rota) length_..__._Lzp ... <br /> Seepage Pit: Distance to nearest welll--------..............Distance from found at ........Distance to nearest lot line.................. <br /> ❑ Number.of pits----------------------Lining material. . ... ... .....Size: Diameter.--.--------------------Depth......................... <br /> Cesspool: Distance from nearest well-----------------Distance from foundaticn...................Lining material._-_-.____-_._-_._--______--_-.--__._ <br /> ❑ Size: <br /> aterial------------------------------------- <br /> Size: Diameter----------...........................Depth_--------------------_----- --------------_-----Liquid Capacity.....------.------------...gals. <br /> Distan—ce4from—nearest well ------------------- 71ding........;.. -------------_------ <br /> ❑ Disfance" to nearest ]of line-................. .........................-----•------------------------ ---------------------------- ..... . <br /> Remolpling and/or re airing (clescr�be):_ 4_4/ <br /> -- --------- <br /> ---epr�A.e. <br /> �4 lee -------------------------------- -----------_-------------------------------- <br /> I hereby certify that I have prepared this application and that X. work will be done in accordance with San Joaquin County <br /> ordinances, State laws, andirules and regulations of the San Joaquin Local Health District. <br /> (Signedy-------_-- ..............--------_._. ......... .........(Owner and/or Contractor) <br /> B (Tifle)- <br /> (Plot -----------------f---- ---------------------------------------- <br /> plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> . ................ <br /> APPLICATION ACCEPTED BY------------------ --- --- .. ................... DATE-------------- <br /> q r 020�4/------- <br /> REVIEWED BY---- -------------- &..... .. --------------- ............ DATE_._. -----------............................ <br /> -------------------------------- <br /> F. <br /> L QI�N <br /> -Q.L _9�,PERIVIITJ SUED_------------__....... - --------- ----------­-------------------- --------------------- DATE____-------------------------........................ <br /> - = . . _­ ­_�—0 77" <br /> Alterations a--nd/o--r- Ions: ......]�` .i <br /> recommendations:__ --------- -------------------------------- <br /> ................ 43 ----1---------_—------------------- -------- <br /> -.............»..___.U . ..T-A��VA I-_ - -_- . ­T­­--------------------------- .T <br /> -------------------------------------- ....------------ --------------------------- ...................I----------------------------:..... -------------------------------------------------- <br /> ------------------------------- ...........................------------__-------­--------------___--------------------­................................................. <br /> ---------------------------------------------------*-------------------------------- <br /> ------------------------------------------------------------FINAL INSPECTION INSPECTION BY:-------- _---------------_--- Dafe_... c.5 .................................. <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-9-21M 8-51 Revised W-2100 <br />