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t4A 09 APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date issued ---�/,A�/­" 7- <br /> Applic*7io—n is hereby rrtade to the Son Joaquin Local Health District for a permit��c n!t"install the work h6rein described. <br /> This application is made in compliance with County Ordinance No. 549. V <br /> JOB ADDRESS AND LOC TION__ <br /> - ------ -- ----014 <br /> .Ir <br /> Owner's Name_______ -- ------- ----- 7—j ------------------------------- - Phone--------------------•---- <br /> ----------- <br /> Address. <br /> hone------------------------------------ <br /> Address. - ---- - ------ ---- ­.... --- - ----------------- -------------------------------------------------------------------------- <br /> - ---------- -------- <br /> 914-- <br /> Contractor's Name-----•---/441----- ------ - --------------- ---- - -- ----- ----------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial.E] Trailer Court (-] Motel E] Other E] <br /> Number of living units: J.--- Number of bedrooms_ Number of baths -,X- Lot size ------------------- <br /> IF- I I <br /> Water Supply: Public system 5�,-Community system El Private 0 Depth to Water Table��_ __*ft. <br /> 4 <br /> Characferrof So" to a depth of 3 feet: Sand R--Gravel V'Sandy Loam El Clay Loam El Clay F <br /> I Adobe 0 Hardpan [j <br /> Previous Application Made: Yes E] No g?---New Construction: Yes ' o ff <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> `TSepticu'Tank: 'Distance from nearest wet= istance fpm foundaiion___. ..__._.Matoai__[r_ " <br /> &6%pc ci <br /> - Capacity--- ---------------- <br /> No. of compar - ------------------Size-- ------ �KO Liquid clep�k---; <br /> Disposal Field: Distance from nearest well/)i!��, ., Distance from foundafip___"___ ...0_--.-Distance to nearest lot line....0;?--------- <br /> Number of lines Pengfh of each line._. �__ ------;/P-.Width of french------eV'O'e---------------- <br /> Type of filler mat -- --- -----4epth of filter material___lap-ee..... <br /> _75pii- <br /> erial ---- Total length---- ---------------------- <br /> ------Disjanqe to nearest lot <br /> Seepage Pit: Distance to nearest well...?2,V",_4—. __Disfance f om tonclafiort-_ - 4... P line'-If----------- <br /> Number of pits____/----------- -Lining material_ -a-- -- ---------Size: Diameter__-.3 .---C-------Depth---2491 <br /> -----------I----------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundafionv .---------------Lining material""-____--.."""""-__-__-""_"""._""_"". �` <br /> ,❑ Size: <br /> aterial----- -------------------------------- <br /> Size:-Diameter------------ - - - --,Depth--------------------------------------------------..Li uidTCapaci - ---------_gals. <br /> Privy: Distance from nearest well------------------------------ ------------------Distance from ne;�resf building.__--__ ."_..-___"-._______"-_"---.-_-- }p <br /> ❑ Distance <br /> 16ilcling----------------------------------------- <br /> Distance to nearest lot line-----------------------....... ----------------------------------------------- <br /> ------------ <br /> --------------------------------------- <br /> Remodeling and/or repairing (describe):__.__-----e4. <br /> -------------------------------­----------------- <br /> ------------------------------- --------­----------­---------­---------------------- ----------------------- --------------------- ---- ------------- ------------------------------------------------------------- t <br /> r- -Ao4 -,A ­� <br /> ------------- --------------------------------------------------------------------- _7A --- -------------- ­ - --------- -----I--------------------------------•--------------------- <br /> fir. <br /> ------------------------ ----------- ---------------------------------------------- ------------------------------------------------------- ----------------- ---- ------- --------------------------------- ---- <br /> I hereby certify that I have prepared this a �licaflon and that the work will e done j accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Loc Health District. <br /> (Signed)..----_---------------- <br /> W�j, ......... .................. Contractor <br /> A ej 0- 4-11 1 <br /> By:--------------------------------- ........ f) � - ;wp ff10f1WW--------------------------_--I <br /> ------------------------------------------------- (Title)-- <br /> n r- o <br /> (PI6;f <br /> pan, s owing siie—of 'I6c­afi6�"­f--!iy-sf'im--i ,relation Wt 1'on f o�w eil I s, buildings,i-I d-i g—se t c—, can 166­pG�e rr_ei;Wfeliiide). <br /> % FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.I`a�-----C�� ------------------------------------------------------- ---------------------- DATE"= <br /> REVIEWED BY----------------------------- _-Z----------------------------------------------------- <br /> --- --- --- <br /> -- ----- DATE- CWS_----------- <br /> BUILDING PERMIT ISSUED---' -- ------------------------------- DATE----:..a----------------------------------------------- <br /> ---------- -------------------------------------------- ------------------------------ <br /> - <br /> Alterations and/or recommendations:-----------------------....._ ------------ ----_----- ----------------------------------------------------------------------I---------------------------- <br /> --------------- ------------------------------------------------------- --------------------------I--------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------­------------------------------------ ---------- --------------------------:-:------------------------­---------------------------------------------- ---- ---------------------------- <br /> --------------------------------------------------------------- --------------------------------------------------------------------------------------------- ---------------------------------- -----------------­------- <br /> ------------------ -----------------------1----------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - ------- -- ---------- Date------- ------------------------6_. <br /> FINAL INSPECTION-BY:-- -- <br /> - ------------ --------------- ------ - <br /> 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 /> E5-3 145446 ATWDCD <br />