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APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete-in Duplicate) <br /> Date Issued --- t <br /> AM: <br /> Application-is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor h ein described. <br /> This application is made in com iance with Cou ty Ordinance No. 549 <br /> JOB ND LOC TI --- ------ - ----- -- -- ----- <br /> JE-S <br /> ADDRESS jm. <br /> ---------- Phone------------------------------------ <br /> -­ -- ----------- <br /> Owner's. --- - ----------- ----- -------------------- ------------- -------- <br /> e Z-- --- ---- <br />' <br /> --- --- - _ _ -_ ---- --- - ----- --- ------------------------­---­­--------------1--------------- <br /> Address----------------_----7i_240------------- ----- <br /> Phone---------------------------------­ <br /> - - -------------------------------------------------- <br /> Contractor's Name--- --- -- ----------- <br /> Installation will serve: ResidencteNI"'Apartment House El Commercial [] Trailer Court 0 Motel Ej Oth <br /> -------_------ <br /> Number of living units: ___1--- Number of bedrooms ---/--- Number o <br /> �-baths ---/--- Lot size -- --------- <br /> "Water Supply: Public system E] Community system El Private NK/Depth t Wafer Table -------- it. <br /> m I b Hardpan C] <br /> Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam Clay Learn [] Clay 0 A( <br /> C <br /> "Yes 1-1 No W New Cohsfruction. Yes No E] FHA/VA: Yes 0 No <br /> Previous Application Made: E <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'ces'spool permitted if pu%s6veris available within 200 feet. <br /> is <br /> 11:11�)A-nferi &------4:----V- -------- ------- <br /> ___4.... ista e fTom tQunclation__-_�_�__V___-Ma <br /> So ank: Distancelfrom nearest weli---------------- Liquid qepMjL-------- ------ <br /> No. of compartments----- .Si ____XXX- -------- ......Capacity---- <br /> py ;;- I-------- q I:: t <br /> Distance nearest wel)C50�ye' <br /> �i�tance-from fi�undafionli;I`1Distance to nearest ]of ine <br /> Dis Reid: D _­ "-'r---- ------ - - __0-------W �1.1 A —-------- <br /> Number of lines-----____-- - ------�en " of each line--------------(V- - ----- -,Clfh of trench---------- rV____ -1---------------- <br /> . .................. <br /> Type of filter materia_ _ fh of filter maf6rial--------L9........Total length.-------------- <br /> p 's, <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundatio;-------------------Distance to nearest lot line-------------- <br /> ❑ 6 -------------- <br /> Number of pits---------------- ---Lining material-------------- ------._Size: DN,meter-----------LL------------Depth------------------- <br /> e from'foundation---- _-_____:__._.Lining material____.____.________.-_.______________- <br /> ❑Cesspool: Distance from nearest well------------------Distanc40-a <br /> Size: Diameter--------------------------------------Depth------------------------------------- --------Liquid Capacity-------------------- -------- Is. <br /> building__________.__--.-__________________-___ <br /> Privy: Disfance from nearest well--.----------------------------------------------Distance from nearest <br /> ---------------------------­-------------------- ------------------- <br /> ❑ Distance to nearest ]of-line-------- ----------------------------------- ---------------------- <br /> innd/or repairin 5 ribel:----------------------------------------------­-----------------------I---------------------------------------------------------------------------------- <br /> _*c �K�--------L-------------------------------------I-------------------- - <br /> ------------------I---------------------------------- ---------------------------------------- <br /> -- -- - ---- --- ---P------------- I 'I -----------L-L------------------------ <br /> ------------------------------------------------------ --------------------------------------------------------------------------------------------­-------------------------------- <br /> ---------------------------L-------------------­­------- ------------------------ <br /> --------------­_­--------------------------------------------------- <br /> -----------------------------------------------I----------- <br /> I hereby certify that I 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 /> t --------------------------------------------- <br /> -----L---------- -----:--------- _�-------------_______________(Owner and/or Contractor) <br /> 1I (Signed} <br /> By. showing <br /> �.o --------------t--(Title)----------------- ---------------------- --------- <br /> -- -- ----- -- ---- ------------- --- ------- -- - -- - ------ - ---- ----- -- - <br /> (Plot(plan, <br /> plan S� w-i-in-g­size o-f_lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLKATION ACCEPTED BY--- -------- ---------------- -----------------------------------------------------------I---- DATE A--=----------------------------------------------_ <br /> REVI�WED BY--- -----------------------iQ—x--------------------- ----------------------------------------------------------- DATE -'r-----------•--------------------------------" <br /> BUILDING <br /> ---------------­ <br /> BUIL6INGPERMIT ISSUED---------------------------------------------------------------------------------------------------I DATE-------- bQ------------------------------------------------ --- <br /> Alferafi ns and/or r;ecKmen allions:----------------- ---------- i��--------- ----------------/­ ...... <br /> -------------- <br /> ------------------- A -- ------ <br /> V <br /> ---- ---- -- ------------ - - -- -- <br /> ------------------------- <br /> V/ ------vl,6 -------- <br /> ------------- -----------r--------------------------------------------------------------------------------------------- ------------------- -------- -------------------------------------------------------- <br /> --------------------------------------------------------------------------- - <br /> ------------------------------------------------------------------ ----------------------------------------------------------------------------- <br /> FIN AL INSPECTION BY:---- ---- -------------- Date --------- 5�f-- -------------------------- <br /> W, )- ---- -- -- - ----- ------ <br /> SAN A1Q; UIN 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-1-9-2M Revised 1.57 FTF'Co' <br />