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APPLICATION EOR�-SANITATION PERMIT Permit No. .. <br /> .: - ---------47/� <br /> (Complete in Duplicate) <br /> V-0 <br /> Date Issue _ <br /> A.plica-lion is hereby�ad6,fo`the San Joaquin Local Health D'isfrict•for` permit to construct and install the work herein described. `fv� <br /> T jis application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN CA�ION --/f - _ _ __. ! -9-__- _-{_ _-- ---------------- <br /> T------------------------ ------------ <br /> 1Z <br /> - , <br /> -OOwner's Name__ --.-- -------------• ----- ------ ---••- <br /> - - -- ----•--- <br /> pne-- <br /> Address.------..� .. ...... _ ---------------------------------------------------- -------------- <br /> 'Contractor's Name =' -� .: 1'ho e_ �� <br /> �l / -------------- <br /> Ins+allation will serve: Residence ["Apartment House ❑ Commercial [J ATrailerwCourt -0 Motel I]. Other ❑ � <br /> Number of living units: ,c __: Nu.mber of bedrooms __A Number of baths Lot size <br /> Water.Supply: ' Public's stem: 0.mmunit l s stem'a Private De th to Water Table <br /> Ck aracter of soil to. a depth of 3 feet:''Sa�d .Gravel ❑ Sandy Loa [❑ ClayLoam ❑ _Clay ❑ .Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes;❑ } No.,. New Construction: Y-e_sj5�No [] -{#. ' <br /> III! , . .. _ t 1 < .. i . . Y. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) -f } <br /> apt ank: Distance from nearest well ----- <br /> . _$Distance from 'foundation--------------------Material <br /> No of cornpartritehis----------------= Size _-.------------------------} Liquid der) - ---------tCapacity_ - <br /> .... ..... _ f <br /> Disposal F Id: Distance prom ea est well .Dislance fro-foundation___,/_ f Distance to nearest lot line___ U-�r <br /> Number of,lln`es�_ yLengtfi7of�each line �/ "I <br /> i ��' Wldth of trench Y:' -'--------- \?} <br /> T e os fitter matenal I r <br /> yp r ? Depth ofell'ter material..._- _---._-Total length------/f- - <br /> Seepage .J .,1 i_. µ x <br /> Pit: stance to nearest well_ 1 _._-_Distaan e�from foundation---_3n.':.•..Dista ce to nearest lot Ime ---------- <br /> Dis <br /> Number of pits °_ =Lining•materi6I. ize: Diameter-'=- - �� Depth � -_---` -------- <br /> Cesspool: Distance from#nearest wi=11___._.__ e_____.Dlstance from foundation__._.________________Linin "material__-__________.___--.--. ____-._. {0 <br /> Size: Diameter _. ------ --x'-- .Depth ------------------------------------' :-- Liquid Capacity---- ----- =t gals. �{► <br /> PrPvy:: Disfance from nearest well------------------i_ :__+----___._,--____l=_Distance from nearest buildin _I_ <br /> j❑ Y_ Dlstarice to nearest lot line _ _, f <br /> U - <br /> Remodeling and/or repairing. (descrb = . <br /> IIS � ---- ---- ,� � _ --------. .. --------- --------- <br /> ------••----••------------------•-••------------• --------- <br /> --- ------- -------=--=------•-- <br /> 4. <br /> ----------------------- - --------------- ------------ <br /> ------------------------ _---_-_-________-..-___-___________________..____-__.____-_ <br /> � I I hereby certify that I have prepared this applicatioh and,that theworkwill be done i�accordance with San Joaquin County `! <br /> ordinances, t e "laws, and rules and regula'tions'of"the San Joaquin ca ea <br /> riot. <br /> 7 . �• .. ff.... <br /> {Signed}. -_...... ..; - ------------- --- Ljw'nh6r and/or Contractor) <br /> (Plii � B r.(.I.� G <br /> IY=--------- ------------- -r--- -- ---------- -- -------- <br /> t plan; showing size of lot,"location �f system in relation to wells, buildings, etc., can 6e placed on reverse side). r <br /> FOR.DEPARTMENT USE ONLY <br /> R EIV I EW SD BY -D gY, = _.DATE_-------� <br /> APPLICATION ACCEPTS -- - -----=----------------°----------- ----==-�-'-------= - -- <br /> �} --------- -- <br /> DATE_: <br /> - s <br /> - -----------•----- ' =------------------------- DATE---=------------- <br /> ING <br /> y r. , _ i <br /> AI leerDt ons and/or7recommDendations---_-_---------- ----.--__ <br /> Y <br /> -----•----------- -------------------------------------------­:------------------------------------------------------------------------------------------: -------­----------------------------- <br /> 01 <br /> ---- <br /> --------- ------------•------------------------------------------ <br /> ---•-----------------------------------------------=----...__ ---. <br /> ------------- <br /> r . . . ....,t - <br /> •-----------•-•------- tl --------- <br /> i i <br /> ' 4 <br /> -------------------------------- -------- y <br /> s - <br /> F NAL•-INSPECTION�BY.- --• :�__,_ <br /> ------ Date <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 /> ' I <br />,2_1$1_7972M ; ' Revised W-2100 <br />