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It -APPLICATION FOR SANITATION PERMIT Permit No. -------- <br /> (Complete in Duplicate) <br /> A Date Issued <br /> A c made t <br /> T�.pliia-lion is hereby m 'the San Joaquin Local Health District for a perm o construct and install the work herein described. <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION i 7 -------------- --------------------------------------------------- <br /> -------- --------- --- -----------4- -77 -1 P: <br /> Owner s Norge--------- u4 <br /> ------ ------- --------i--------------------- ---------------------------- Phone-2 <br /> Address---------- -7- <br /> ---------- --------------------------------------- <br /> ti <br /> actor's Name........ �_w"i-_ -------------------------------------------- Phone,� <br /> Confr ------ <br /> Installation will serve: Residen'9e Er-Apartment ouse Comme�<@I_Fj_TraiIerjC6!urt 0 M.ofel Ej Other E] <br /> Number of living units: Number of bedrooms Number of baths LoEsize ----------------------- <br /> Water i' Supp ly: Public system (,Community system Dtt_Ptivate OS(Dep'tK-to--W.ate�.J661j'!K'S--:ft.'-" <br /> Character of soil to a depth of:13 feet: Sand L] lGravel E] Sandy Loam' E] Clay Loa E].' C1] Adobe [Hardpan L] <br /> M <br /> Previous Application Made- Yes [] No W--Newl Construction,: Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS,:� <br /> j ) <br /> (No septic tank or'cesspool permitted if public sewer �Saaila blewif hin 200 feet. <br /> S%e 'c Tank: Distance from nearest well--------- ------Distance_ from foundation--.- __-�Maferiai--------- -------------- ---------------- <br /> No. of con�pa'rtments---------------- <br /> 4�t I -- ----- -----------------------Liqui� dtpih---�*---------------- ----Capacity------------------------ - <br /> QusposalField: Distance from nearest well........I----------D�stance from foundation--------:11......Disfance'to nearest lot line----------------- <br /> Number of,lines------------------ - --- Length of each line----:------.....------ - _----Width of trench----------------------------------- <br /> ..-Depth-of-filter-mate.rial----------------t----Total length-- ---------------:---------- <br /> Type of fi�fer material--------------- ------------- <br /> 0 <br /> Seepage Pit: Distance nearest w4elO---- .---Distance from foundation---/47-- -­Disfance to nearest lot line____,__--_-____- <br /> Number <br /> ine----------------- <br /> Number of!pits-------/------------U,ing material-.S',-- -.Size: -----------i <br /> ---------- <br /> Cesspool: Distance i1i'm nearest weil-----------------Distance from foundation-------------------Lining material--.------_-_----_-_.-----_-`_-__-____. <br /> ❑ Size: <br /> aterial-------------------------------------- <br /> Size: Diameter-------------------------------------Depth-------------------------------------- -------Liquid Capacity--------------------------1-.gals. <br /> Privy: Distance fr�'om nearest well------------------------- ------------------- -Distance from nearest building--`------------------__---___---__-.--- <br /> - e - - ----------- <br /> n Distance to nearest lot line-------- - ----------------------------------------------------- -------I------------------------------------ -- ---------------------7. <br /> Remodelingand/or repairing (describe):-------- ----------------- -------------------------------------------------------------------- -------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- <br /> -------- <br /> --------------------------I—-------------------------------------------------------------------------------------I..............­-­--------- ------ ----------- ------ -------------I-------------- <br /> -----------i-------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------ ---------------------- <br /> I hereby certify that] have prepared this application and that the work will be done-in accordance with San Joaquin County <br /> ordinances, State laws,-and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) -------------- i � ..... ----------%------ ------- -- ---- er and/or Contractor) <br /> (By:---------------------- ---------�. —-----------------------------------(Title --- -- -------------- --- <br /> (Plot plan, showing size' of lot, location of.systern�fi""relation to wells, buildings, etc., can be placed on reverse side). <br /> P FOR DEPARTMENT USE ONLY <br /> ----------Z-------------- DATE---------------- --------------- <br /> APPLICATION ACCEPTED BY------------ -------------------------------------------tj rsz <br /> REVIEWEDBY---------------------------: -------------------------------------------------------------------------------------- DATE-----------------------------------------I----------------- <br /> BUILDINGPERMIT ISSUED----------------------------------- ------------------------------------------------------------------- DATE-------------------------------:---------------------........ <br /> AI er -- - ----------- <br /> --------- <br /> e- -, - - ..............­------ <br /> ----------------------------------------------------------------------------------- ------------- <br /> ------------------------------------------------ ------•--------------------------------------------------------------- :---------------------- -------------------------------------------------------------------------------------------- ------------------------------------------ ------------------------------ <br /> FINAL' INSPECTION ----------------------------------------------------------------------------- <br /> Date_------------------- ------------------------------------------ <br /> --------- VIP <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 />