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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) Date issued <br /> dit to construct and install the work herein described, <br /> �Apisa <br /> o tion is hereby made to" the San Joaquin Local Health District for a perma 0 cl, N 9 Thpplication 'IS made in compliance with County Ord once 5111- . --------------- <br /> a )��_ ____ ------------------ d5 <br /> . ...... --- <br /> ...... .... ...... <br /> VDCATION --- --- <br /> ------------ <br /> JOB ADDRESS A Phone_ <br /> -------------------------- <br /> Address__._ <br /> --------------------------- <br /> Owner's Name------ ----- ------------- -- ----- -- --------- ----------------- ----------------Add ress-_3_1=1�_- ­��­l -1--- - ----------- <br /> Contractor's Name_ - ---------------------------------------------------------------------I------------------- -------------------- Phone----------------------------------- <br /> 0 her 0 <br /> Commercial El. Trailer Court <br /> House El M <br /> Residence Apartment <br /> Installation will serve: bedrooms -%5- Number of baths __Z__ Lot size _5:1576-t-.X - ---------:--------- -------- <br /> Number of living units: __Z__ Number of F] Depth to Water Table --------- ft. <br /> Water Supply: Public system Community system '[] Privateam Clay Loam [I Clay 0 Adobe Hardpan 0 <br /> Character of soil to a deth of 3 feet: Sand OGravel 0 Sandy Lo No F1 <br /> Previous Application Made: Yes Fi � rNew Construction: <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> permittewelf_ <br /> uwer is available within 200 feetj I(Noseptic tanorcesspoundal.- ---Material---------------------------------------I-------earest KSepti kDistancefrom nistance from-m__f------------Liquid depth--------------------------Capacity----------------------- <br /> No. of compartments--------------------------Size------e--from foundation-----------—-------Distance to nearest lot line-.--------------- <br /> Disposal Field: Distance from�i'nearest well-------- <br /> ell---------------.-Distanc -- --__width of trench -------------- <br /> El Number of lines_______________ Length of each line-----------------------------Total length------------------------------------------ <br /> Type of filter material-------------------------Depth of filter material------------------ <br /> _Distance to nearest lot line--------------- <br /> Distance to nearest well----------------------Distance from foundation----------------- Depth -------4---------------- ---❑ - <br /> Seepage Pit: Number of pits_____. ------------ Lining material-----------------------Size: Diame)er------I----------------- <br /> I --- f dation__!-- --------------Lining material-- __4-- ---- ---- <br /> ne f we _*OlDistance from fou Distance from-TF --------------------1------Liquid Capacify­_/___ -0- ---------gals. <br /> 'e5 <br /> Size: 948 -------Depth-------------------- -Distance from nearest building------------------------------------------ <br /> Privy: Distance from nearest well------------------------------------------------- ----------------------------------------- <br /> 0 Distance to nearest lot lme--------------------------------------------------------------------------------------------------- <br /> 0 - ­------------------ <br /> Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------------------7 <br /> -------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------I-------I---------------------_------------- ----------------I------------------------------------------------I----------- <br /> --------------------------I------- <br /> -- --------- --------- --------------I------- <br /> - ----- ---- ------ --------------- - - -- -------- ------------- --- <br /> . <br /> -----------------•-----------------------------------f- <br /> --- <br /> ------I------- -------- <br /> ------------------------------------------------------- -----------------------------------------------------------------k__will__be- <br /> done- - in accordance d an c e w th San Joaquin C ounty <br /> I hereby certify that I have.prepared this application and that the wor District. <br /> ordinances, State/liws, and rules and regulations of the San Joaquin Local Health <br /> -------------------------------------------(Owner and/or Contractor) <br /> (Signed)-----4-n-e��--- <br /> -------------------------------:--(Tifle)---------------------------------------------------------------- <br /> ----------------- <br /> By:-:....---------------------------------------------------------------------- wells e placed on reverse side]. <br /> (Plot Ian, showing size of lot, location of system in relation to buildings. etc., can b <br /> FOR DEPARTMENT USE ONLY <br /> DATE--;5"-- --------------------------------------------- <br /> -------------------------------------------------------------------------- <br /> APPLICATION ACCEPTED BY-._k_ DATE---------- <br /> DATE-------Fj; ---------•-------------•------------------- <br /> - <br /> ---- ------------------ <br /> REVIEWEDBY----------------------------- DATE--------------- -------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- --------------------------------------------------------- -------- <br /> ----------------------------------------------------- <br /> Alterations and/or recommendations:------------------------------------ --------------_­--------­----------------------------------------- <br /> ------------------------------------------------ ---------------------------------------------I------------------------------------------------------ <br /> ---------------------------I------------------------ --------I------------------- ----I--------------------------I--------------------------------------------------------------------------------------- <br /> -------------------------- <br /> ­ ------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------I---------------------------- ------------------------------------------ <br /> -------------------------------------------------------------------- <br /> --------------------------- <br /> I --------------------------- ----- <br /> ------------------------------ Date- -W -----C--�--I-- "----------------------------- <br /> FINAL <br /> ----- <br /> -------------- -------------- <br /> FINAL INSPECTION BYW-V-4------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> 130 South American Street Lodi, California Manteca, California Tracy,'California <br /> Stockton, California <br /> ES-9-2M 8-51 Revised W-2100 <br />