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APPLICATION FOR SANITATION PERMIT Permit No, <br /> (Complete in Duplicate) <br /> _2 Date Issued <br /> ThiApplica+ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> s application is made in compliance with Cou?ty Ordinance No. 549. <br /> JOB ADDRESS ANDATIONA <br /> Owner's Name---- J#TOR --- <br /> ----------- -------- <br /> Phone------- <br /> 9e_ ------- -------------- <br /> --f---- --------- ---—------ <br /> Contractor's Name.____ � <br /> Addres ....... ------------------------------------------------------- <br /> ;;�------ -------I--------------- Phone.. <br /> Installation will serve: Residence Apartment House ❑E] Commercial El Trailer Court E] Motel E] Other El <br /> Number of living units: Number of bedrooms Number of baths __/_ Lot size, <br /> - --- <br /> Wafer Supply: Public system ❑ Communitsystem <br /> y 0 Priva4e R`Vepth to Water Table 4----- <br /> ,*If t. <br /> Character of soil to a depth of 3 feet: Sand El Gravel Ej Sandy Loam E] Clay Loamk- lay [I Adobe 0 Hardpan <br /> Previous Application Made; Yes [I No J�T' New Construction: Yes o E] El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Q) <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 14—A &r <br /> Septic Tank: Distance from nearest well- d----_- Dist fwm foundation----/0-------.-.Material-- AA <br /> - <br /> - ---- ----- <br /> No. of compartments--.. -------- <br /> --------Size— Liquid dep�h----- Capacity--- <br /> Disposal Field: Distance from nearest0, F - -Z- -- --w�0 A--,---Distance from foundaf*0A4;2P---- ------Distance to nearest lot.line__,�& <br /> ------ -- ----------- ------- <br /> Number of lines---____/ Length of each line......Y47---- Width of french.-----Asr <br /> Type OT filter material-__'? 14F ?$011 <br /> A J"-Depth of filter mate ria I-- ----------Total lengfh----- ---------------------- <br /> Seepage Pit: Distance to nearest wellfoundation___________________ <br /> 11 --- - <br /> Number of pits------ -------Distance from foundation------------------Distance to nearest lot Ii'ne-- ---- <br /> -- -------------Lining material---------- ---------- - Diameter <br /> --Size. ----Depth------------------------------ <br /> Cesspool: Distance from nearest well------------------Distance from found0ion--- ---- <br /> -1 ------------Lining material__.____"---_____._."_.________- <br /> - Size::Dia nneter-_.. -------------------------------Depth-------- ----------------- ------ --------------Liquid Capacity........ ---gals, <br /> Privy: Distance from nearest well------------------ -----------_---------------Distance from nearest building------- <br /> ---------- - <br /> El Distance to nearest lot line_____________________ <br /> Remodeling and/or repairing (describe):---------- <br /> .......... 1 <br /> ------------------ <br /> ------------­---------------------------- ------------------------------------- ------------------------------------- ----- ------------- -------- ---- --------------------------------------------------------- <br /> • <br /> --------------------------------------------------------------------------------------- Oxy <br /> ------ -1 --- ------------------------------------------- <br /> ------------------------------------------------------- <br /> I hereby certify that I have prepare le <br /> ----------- -------------------------------------------------------------- --- ---f- <br /> be <br /> -------------------------------------------- <br /> d this application and that f work will be ---------- <br /> Z.14.1. one in ac rdance with San Joaquin County <br /> ordinances, State laws, and rules and regulati s of the San Joaquin Local Healfhoisfrict. <br /> (Signed)-------------------I'll:.-----•-----------•-----• <br /> 57 1— - <br /> 11_1-----10, <br /> By:----------------- - ----- -------------------------------------------I-- Contractor) <br /> -------------*------------- <br /> ems <br /> ----------- <br /> -------------------------------- -----(Tif le)----- -- - - <br /> (Plot plan, showing size of lot, focati" system in relation to wells, buildings, etc., can be laced on reverse del). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> REVIEWED BY - <br /> ----- <br /> REVIEWED `�I ----------------------------------------------------- <br /> DATE <br /> BUILDING PERMIT ISSUED._______".-- ---------------------------------------------------------------------------------- --------------------------------------------------- <br /> AlterAlterations and/or recommendations:------------------------------------------------------------------------------------------------- DATE----- -- <br /> ations --------------------- ---------------------------------------------------- —----------------- ----------•--------•---------- <br /> r ------- ---- _60--17---r--------------*------ , ?` <br /> .4 ---------------*------------------------------------------------- <br /> OLY <br /> ----------------------------- ------ -------- -----------I-----t_+-- ---- 4 <br /> - <br /> ---------------- <br /> -------------------------------------------------------------------------- <br /> ------------------------------------ -------------------------------------------- ------ - �_j <br /> --------------------------------- .......... -- --- ------ ---- ----------------- ----------------------- ------------- --_----------------- --------------------- ----------------------------- <br /> -- - ------- <br /> ---------------___...... ---------------- ---------------------------------------------------------------------------- -------- <br /> FINAL INSPECTION BY---- ---------- _;_7 <br /> ------------------------- --- -------------- Date----------- <br /> ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> F:5--9-2M 145446 ATWnUD 12-54 <br />