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APPLICATION FOR SANITATION PERMIT Permit Na. _.L.Y7 d <br /> t---------- <br /> (Complete in Duplicate) —Date Issued .__7h/5 <br /> Applica4ion is-hereby ma:1de to the Son Joaquin Local Health District for 6 permit to construct and install the work herein described. <br /> This application is made in compliaince with County Ordinance No. 549. <br /> JOB ADDRESS A�N�DOCATIOI` <br /> __. --(��f�?'�e __ 4-�/I _44 -W^------j eow"ves <br /> ----We__4__*-79/5. <br /> Owner's Name-___A.k_ckx_-,,-ax----- _40=404f---------------------------------- <br /> v6 .1570 <br /> Address-.---------------------------- ---- ------------ <br /> -------------- ---------- <br /> Contractor's Nami -------------------------------------------------------------------------- Phoe__7VV__4jF4a7------ <br /> Installation will serve: Residence E?"*Apartment House E] Commercial [] Trailer Court E] Motel [I Other E] <br /> Number of living uniis: Number of bedrooms __Number of baths Y--- Lot size <br /> Water-Supply- Public system Community system El Private Eso Depth to Water Table <br /> El-;` r-16", <br /> Character of soil to a depth of 3'feet: Sand Gravel [] Sandy Loam <br /> X Clay Loam- E] Clay ❑ Adobe UR-11ardpan 0 <br /> Previous Application Made::r_Yes New Construction: Yes [?'.No El <br /> TYPE OF INSTALLATI'01` 'XiNb SPECIFICATIONS: <br /> (No septic fanVor cesspool permitted if public sewer is available within 200 feet.) <br /> loo <br /> ic TOO: Distance' from l ________Distance from foundation---!a-----------Mafe," I.­ <br /> Sept nearest wellko- 34 ]a-------------------------------------1>0------ <br /> :NoA. :of c`ompa4ments_.Z__.--------------- --Liquid clep�h----- Capacity,/ - <br /> I AR-op o -_ --- <br /> Is11. <br /> Disposal Field: -Distance from.nearest wefila_**!�'-.Di,tance.from foundafion�-i--'�--O----- Distance to nearest lot line--- <br /> Number 8Viines-- - ------- Length of each line____15--Q!_________.Width of trench_-_--�:24C� <br /> ------------------ <br /> Ty e o� filter of filter-material--- "*------Total lengfk_`j_]�. <br /> Type material--/ <br /> d lot line----Z <br /> 5 e o near. :we - Dist from foun 5fion _42:7�___.Disfan�� fi3 nearest Seep t: Distance st, 11 _40.0_:_____Distant r <br /> Number r-------------------Lining m aferial- Size: Diameter--- 47�--------------- <br /> Cesspool: :Disfance'frorn nearesf"well---------'_-L.-Distance from foundation-_.------------------Lining material__________________________________-❑ - <br /> I - -11 <br /> Size' : Diameter--------------------------- ----- --__De th-------------------f <br /> --------------------------------�Liquid Capacity----------------------------gals. <br /> Privy:' Distance from nearest well________________________" ----------- <br /> --- --------Distance from 'nearest building.___.______*.__-__--------_--:_-------- <br /> ,` ❑ <br /> uilding------------ ---------------------------- <br /> F-1 .,,..Distance to nearestlot line------- "------------=--=--- ----------------------------------------- <br /> Remodeling and/or repairing (describe):--------- ---------------------------=---=-----------•-•-- --------------- R------- 1 ------- <br /> --------------------------A---------------------------I----------- <br /> ----------------------------------------------------------------------------------------------------- -------------------------------------------------- <br /> -------------------- ----------- -------------------------------------------------------------------------------------------------------------- <br /> -------------------------- <br /> -------------------- <br /> -------------- ------------------------------- -----------------------------------------------------------------------------------------------------------------------------I------------------------------------------------- <br /> I h b ortify-that have prepared this!ppJlaaf ion and that the work will be done in accordance with San Joaquin�County <br /> ordinances, at laws' rules nd re ns of the San Joaquin Local Health District. <br /> ----- --- ------------------------------- _L_jQmm@pp@sWw Contractor) <br /> }Signed)-----------• -- - -------------w- --------- -------- <br /> 1 7. <br /> By:__...................---------------------------------------------------------- - - ------ --- ----------------- ------------------------ <br /> Id m <br /> (Plot plan. showing size!of lot location of system in relat--*Ito to wells, buildi S, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYDATE-I <br /> -------------------------------------------------------------------------------- --- ----------------- ------------------ <br /> REVIEWEDBY------------ ---------------------------------7--------------------------------------------DATE_._::�--------------------------------------------------- <br /> BUILDING PERMIT ISSUED----------------------------------- ---------------- -- ----------------------------------- <br /> --------- ..1. --- 9-r <br /> DATES <br /> --------------------------------------------- <br /> Alterations and/or recommendations:-------I------ --------------------------------------------------------------------------------------------------------------------------- <br /> -------------­--------------- -------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------------------------------- -------- --------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------- - ----------- ---------------- <br /> ------------ <br /> --------------------------------- ------ ----------------------------------*-------------*-------------***------------------- <br /> ------------------ ---------_------ - --------------- - -- <br /> - ----------------------------- ------ ------ ---------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:------==--------- -----I----------------------­-----i----- ----- -Date------------ <br /> j 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 />