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..................... APPLICATION FOR SANITATION PERMIT- Permit No. (ComRlete in Duplicate) Date Issued/Q-1-91, Application is hereby made to the Sari 1 Jd4aquin Local Health District for.a permit to cons# uct and install the work herein described. This application is made in complianceWith County Ordinance 549. JOB ADDRESS AND LOCATION----------- -- -------- ----- Owner's Name----- ----- - ----------1--------------------- Phone Address----------- - ------ -- ------- - ------ ------- ---- ------ - -- ----- ---- - --------- ----------------------------------------------------------- Phone,31- Contractor's Name,-- --------- --- - - ------ - , r 4 1.f [] Motel 0 Other 0 1 ApartmeM,Hodse [] Commercial [] Trailer Cort Installation will serve: Residence IF , L, ❑9 ---/--- Lot,size ----—---------- Number of living units- j---- Number of bedroomsNumber of baths Community system Water Supply: Public system PrivafeDepfh to Wafer fable -------- ft. El i I Character of soil to a'depth .of 3 feet: Sand E] Gravel [I Sandy Loam El Clay Loam E] Clay 0 Adob�-v Hardpan F] 1 .1 il Previous Application Made: Yes El NaNew Construction': tyes E] Nom N TYPE OF INSTALLATION AND SPECIFICATIONS: Vic sewer is ava�lla,61e within 200 feet.) I (No septic tank-or cesspool permitted .if public 4 -------------- ------------------------------------------------- Distance from nearest well---1------------Distance from foundation -Septic Tank. , .4 ----------------------- e-------------------------------Liquid de0h--------------------------Capacity xNo. of compartments----------- ---- -- 4011 ----------------- Disposal Fieldz/ Distance from nearest well_______-- \Distance from fLndafion--------------------Distance to nearest ]of line Number of lines----------------- ...........Le'n9th.of each line------------------------•-------Width of french----------------------------------- Type of filter material---------------------------- ------Depth-of filter material......... ---------------Total length------------------------------------- t lot line-4---------- Seepage Pit: Distance to nearest well------/Y 7m,fou �Iation 2L/-t---D�sfance to nearest ?'.� j ---------- ---------Distance f -�/,alrn e f e r pth----- -i5t--- De _maferia Lining S Number.of pits )1ze: ro ------------- ---------------------------- Distarnce f m foundation ..Lining ma eria Cesspool: Distance from nearest ----------------- ------------ - 'Capacity -gals. 'Liquid. -----------------------1:�-- S�ze: Diameter------------------ ---- --------- P f;well________ 1�'De11 #, ---------------------nearest building------------------------------------------ Distance from neares -------!t�---------------I Distancej rolm Privy: �, 'r *11. F ----i❑ ------------------------------------------I---------------- Distance to nearest lot line------ --------------------------------------------------------------------- Installing new �v,ettt, Cal---dr onthe----ell-d---of---the----------- ,ibe). ----A--------- ------4114 tt, jn he J-P-8 RemoOlinnncl/or re airing (desci --------------------------------- new of orizontal leach draA -,] ae been___ ---in------ -hn -A -- -t-- n ----------------------- put V. ------ ------- ----- --------- -- ------- ----- ---- --- - 6--�&ffths----o-n------an-o-t.lier---e r m d iis-t-an-c-e fro'fii} the---Vg�U---16....oP-P-rQx1xa_t L _ely---7-5----f-e-e-t ---------------------------------------------------P---- -- -------- - -------4------------ ------------------------- ----------------------------------I---------------- -:!�------------------------I--------------------------- -- in County ---------------------- n and that the work will beejonji-iii-acczaidance with San Joaquin County 6reby certify that I have prepared this aF I- � 1'�' iplicati6 ordinances, Sfaf;'laws, and rules.and -regulations.of-the,San.Joaquin Local Health,District. actor) Delta73eitic Tank ------------------------------—------------------------------------(Owner and/or Contr (Signed)-----------------••----------------------- --------------------- (--------" PerryW 1 _,. ,-1 ---------------------------------(Title)------PKqP�r�XgX!,,----------------------------- ------------------------------- By:-------------- --- .............R side). Ian. showing size of lot. lo�c 8f system in relation to wells, buildings, etc., can be placed on reverse (Plot p ation o FOR DEPARTMENT USE ONLY t DATE---- --------------------- &- APPLICATION ACCEPTED BY------ --------------------------------------------- -------------------- ---------- -- ��- ------•-------------------------------------.-------------- f J-;- DATE--------- --------------- • -------------- REVIEWEDBY--------------------------------- ---- --- -- --------------------------------------------------------t-� I ec, * ----------------- DATE------------------i��--------------------- BUILDING PERMIT ISSUED----------------------------•- -1----------- Alterations and/or recommendations:------------------------------------------------ -------------------------------•-------------------------------------- ------------------------------- --------------------------------------------------------- -----------------I------------ ---------------------------------------- - I ---I------%---------------------------------------1-%-�---------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- -- ------------------------ --------------------------------- --- ---------------------wr--2 --11--------------- ---------- ------------------------------------------------------------------------------------------------------------------------------------------ -- - -- Date -lb FINAL INSPECTION BY:----ll �---- ! M----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT . 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y,. ES-9-2M 8-51 Revised W-2100