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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No. Date Issued �' install the a her-, Application is hereby made to the San Joaquin Local Health District for a permit to construct and in;sfall th ork herein described This application is made in compliance with County Ordr*No. 5 9. Ad ----- - ----------------------- ..... --- - ----------- ----- -- -- -------- - N ---- - - ----- -------- JOB ADDRESS AN ---- ------- 4 ---- 7- ----- 7X - -------------- ---------- ------------- ------------ -------------------------- ---------------- Phone/ s Name. ------- V�_ Owner 1<N Address --------------------- ---------------- ;P --- t_ --------------- ------------ 4 _�o ---------------------------------------------------- Contractor's Name_ --- ----- yl__ I - - -- ---------------------------- DOI r m El Commercial E] Trailer Court E] Motel 0 Other El Installation will serve: Resi ence U�I_Kpar ment House ❑ 1ths _j ' >?- / - — ------------------- Number of living units: Number of bedroom" --4- Number of ba ------ Lot size --- SO --------------------------- Water Supply: Public system 941_� -Ommurijty system 0 Private [1 Depth to Water Table 45L�+. Aclobe,4 Hardpan C] Gravel Sandy Loam El Clay Loam 0 Clay 0 Character of soil to a depth of 3 feet: Sand E] 0 ' New Construction: Yes ❑ No? k. Yes -M N80 Previous Application Made: _Yes e_.U_0_P TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or' cesspool permitted if public sewer is ave ila6le within 200 feet.) ' -.0 e 1 - ------------------- ptic Tpk. Distance frorr�-neare�f: well ------ * --------- Titance from foundation-----------= -----Material______.__-.-------.----------- ,a ----- -- ---------------- Capacity_ --------------------- ---------- Liquid depth No. of compartments---- ------ --------- Size -------i------------- - --- 47�__ -,'rom foundafion--I--e---.Distance to nearest lot line - is osal Fi Distance from nearesi well_A4_,0_A--0-t Distancef _.op -Width of trench ---- A_CK:�l -------------- ----- t Length of each Ifne --- 4 pi - Number ofiiihes -------- I ---- _ 9f,_.,.S7 --- ----------------- 1.pi� eng al - --- -- --------- Total length 0( Type of filt6r material:___ -- -- ----- :LDepth Of filter materl ------- 6istance to nearest lot fine____"------------ Distance�to�nearesf well__X�T� -------- Distance om found rom e_a ------ Size: Diarnefer-3--.2 ---------- Dept --- S�k7�^t ------Numb of pif;_�__,_/ ---------- Linin material --- ---- -- 5 er 9 _ Ir 4 . . " -' Distance from foundation -- ---------------- Lining material ----------- -------------------------- Cesspool: Dista'nce from nearest well: ---------- :: ---- Uquid Capacity ---------------------------- gals. ---------------------------------------------------- Size: Diameter --------------------- ----------1_ ---- Depf� I -% ❑ �Distance fro�n nearest building ------------------------------------------ Distance from nearest well -- ---------------'-------------- ---------------- Privy: i lot line -- ---- ---- ------ ------------- ------------------------- 11 ------- ------------------------- ----------------❑-------------------- Di . stance to neares o ---------- ------- -------- -------------------------------- Remodeling and/or repairing (describe): ----- ---- -------- ---- - ---------- - --------- ------ - ------ -- -- -- ----------------- ------------------------- ------ ---------'•----•---------------- --------------------------------- - ------- ----- ---------------------------------------------------- ---------------------- ---------------------- -------------------------------------------------------------------- --------------------- ------------- -- ------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------- I hereby certif that I have prepared this application and that the work ill be done in accordance with San Joaquin County d reg I tions of the San Joaquin Loc alth District. ordinances. Stat s, that rules \ ' 7' �'4/--1 tractor] --------------------------------------- 7--- -- -_-____---_--- ---------------(Title]-- -------------------- ----------------------- -------------- --- By: --------------------------------------------------------------- m --------------------- wells --- buildin din etc.,rcan be placed on reverse side). (plot plan. showing size of lot, location of system in relatio FOR DEPARTMENT USE ONLY DATE-------- --------------------------------------------------- APPLICATION ACCEPTED BY__'------------------- ---------------------------- work 11-y Loc ------ d ------- ----- �io we bu Id n e . can be placed on DATE-------------- - ------------------------------------------ REVIEWED BY----------------------------------------- ------- ------- I ------- DAT BUILDING PERMIT ISSUED. - ------------------------ 7 ---------- a ------------------- ------------------ ------------------------ r recommendations:____--. ---------- Alterations and/o -- -- --------- ---------- - --------- --------- ........... ....... ----------------- - ----- ---------------- -------------------- ------------------- I ----------- --------- I ----- W ---------- --------- ------------ .......... -------------------------- _4 --- ------------ at -- ---------------------------- -------------- -------- -------------------------- ------------------------ ----------- ------------------ -------------------- -------- --------------- -------------------- FINAL INSPECTION BY-------------------------- ---------- Date ------7------- -------- ------ ----------------- ---------- --- ------- ------ SAN JOAQUIN LOCAL H TH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street J30 South American Street California Tracy. California Stockton, California Lodi, California Manteca, ES -9-2 M Revises 1'.57 F.P.00.