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APPLICATION FOR SANITATION PERMIT Permit No. .....7�_F.3.. <br /> (Complete in Duplicate) Date Issued <br /> Zye-0410- 0-7 <br /> Applica4-ion 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 madeOcompliance with County Ordinance No. 549. <br /> *]ON, T.1 . . I <br /> JOB ADDRESS AND LOC A-lea_�.. <br /> ------- <br /> Owner's Name. lk 1 <br /> Phone..................................-.-.-.-.-.-.- <br /> .-,*-''-, <br /> Address.........W-,P....arly3_ ... <br /> --- --- -------.. ........................ ........------------------- ...... <br /> Contractor's Name...... Phone... <br /> _------............ <br /> ------------*---------*----------------------------------------------------------*------*--­------------------ <br /> Installation will serve: Residence,)( Apartment House [—] Commercial F� Trailer Court [] Motel L] Other E] <br /> Number of living units: Number of bedrooms ___0. Number of baths J_ Lot size ----- ............................. <br /> Wafer Supply: Public system Community system 1`7 Private V Depth to Water Table .70f+. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel Sandy Loam;V Clay Loam [] ClayL] Adobe[:] Hardpan ❑ <br /> Previous Application Made: Yes L] No X New Construction: Yes 0( No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 77 <br /> Septi Tank: nearest well...4.6 .D stance fro fo'un ation._.Ltz' <br /> Distance from ne res -------Material_..... <br /> No. of.compartments...... ]....._...___Size_ _ ._ <br /> __ t "_ <br /> P9 ---------.___Si1e__0__,X, X--. _Uquid depth---------- -------Capacity, <br /> Dis al Field: Distance from nearestwell..­6,6...D-"ta,nce from foundofion .....Distance to nearest lot lin q__------ <br /> Number of lines........I............ Length of each line_*rl__� Width of trenj��........ ---------- 0 <br /> T�.w� -Depth of filter eriaL ......Total length-. -­'/5 7------------------------ <br /> Type of filter maierlal_,7 mat <br /> Seepage Pit-. Distance to nearest well----------------------Distance from-foundafion....._._,__._ <br /> --..Distance to nearest lot line..... . <br /> ❑ Number of pits._.._._-...:..........Lining material...-.-----_-----------Size: Diameter7_- .................Depth__._.._.__...._.._.......___... <br /> Cesspool: Distance from nearest well- ........ ._Distance from foundation.....................Linin ___-- .----.__..____. <br /> Size: Diameter ... . ...... -----------------Depth_---- --------------------------------------------Liquid Capacity...... als <br /> L1 ---­--------9 <br /> Privy: Distance from nearest well .------------ i__.__.__.__......___......_Distance from nearest building. ........... .................... <br /> ❑ Disfance'fo nearest lot lire--------.......... --- -- ---- ...... ---------------------------------- ------ ................ <br /> Remodeling and/or repairing .(describe :-----:;K- - ------------- <br /> ................. <br /> r <br /> ------------------------------- ---- ----------- -------- <br /> ­*�,_ ­_�V!' --------------­*---------- <br /> --------------------------------------*------- <br /> t.................. ------ <br /> ---------- <br /> ................................... <br /> ---------_--_-----------_------------------__----- -------------- <br /> ..............---------------------------------- ... <br /> I hereby certify +hat I have prepared this application and that ',#- work will be J�*ne in accordance with San Joaquin County <br /> me <br /> ordinances, State -71s, --- <br /> %anrulles and regulations of the San Joaquin Local Health District. <br /> (Signed) <br /> 7L ...... ---- -- _-- --- ---- ----__ ....... .............. _-----(Owner and/or Contractor) <br /> ------------------ ------------- <br /> By:-----------------------------------------------------------------_------------------------------------------------------ .(Title)--------........ ---------------------------------------------- <br /> (Plot plan, showing`size of lo+, location of'system in relation to wells, buildings, etc., can be, placed on reverse !Ctde)-­ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY.... ------ -------------------------------- -- --------- -------.............. DATE----------------_--.........e-7_____- <br /> ------------ DATE j.._7-72->_4q-------------...... <br /> REVIEWED BY----------------__---......... ............ --- - - ------------ <br /> ---------------_ -------------- <br /> BUILDING PERMIT ISSUED-.....,.... --------------- - - --------------_---------------­--------- DATE <br /> Alterations and/or recommendations...................... ........ ............_-_--------------------- -----------•......... .................I---------------------------------------- <br /> ........................_..........................................................................................................­......................................................................-----------­---- <br /> .............................................__----------------:..........................................­­.................__ _..,.......... ...........................­1........ <br /> ..................................................... ......---------------------------------------------------­­---____-------------------------------------------------------------------------------------------- <br /> .................................Al-A........... ........ ................................------------------- .---•------........-------------------------- <br /> FINAL <br /> .................-----------------­------ <br /> FINAL INSPECTION BY ................... <br /> ------ ---- ------ _- ------------ <br /> .... Date_.. <br /> -- ---------------- <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 <br />