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P—a APPLICATION FOR SANITATION PERMIT <br /> Permit No. .2--- <br /> (Complete in Duplicate) Date Issued <br /> ibd <br /> Application is hereby ade to the San Joaquin Local Health District for a permit to construct and instafl the work herein described. <br /> m compliance with County Ordinance No 9- <br /> This application is made in comp tO -If T -------------------------------- <br /> JOB <br /> ----------------I-------------- <br /> ---------- <br /> JOB ADDRESS AND LO <br /> TION-----' <br /> - <br /> ----------------------------------------------------------- Phone---/ ---P-------------------- <br /> Owner's -N---a--m---e---------------------------- ---------- - - V -------------- <br /> -- <br /> ----- ---- - -- <br /> Address- ---- C- - <br /> Phone------ 7 <br /> Contractor's Name---------------- Other [I <br /> House ❑ Commercial ❑ Trailer Court 0 Motel D <br /> Installation will serve: Residence $�i Apartment H —--------------------- <br /> Number of living units gTrLt-Nu mber of bedrooms -�_ Number of baths &MkLot size <br /> Water Supply: Public system Community system 0 Private [I Depth to Water Tabl,,,,g__ ft. ❑ <br /> �3 Sand F1 Gravel F1 Sandy Loam 171 Clay Loam El Clay E] Adobe Hardpan <br /> Character of soil to a fee 1 t No $. New Construction: •Yes D No <br /> Previous Application Made: Yes 0. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) <br /> [No septic tank or cesspool p7mitted if public sewer is ---(30,1V&K!9,r <br /> yL from founclation__/a---:------I�Iate ---------------- C---- ----1--4 <br /> Septic Tank: Dist nearest well_t lytA-Distance - 1 1 66P---(Frt4 <br /> Distance from nean Sjze.:5'&_- Liquid depth-5-7--------------Capacity-/ <br /> K No. of compartments-_-rvl/o-------- from anon-------------------Distance to nearest lot line-_---------------- <br /> Disposal Field: Distance from nearest well------------------Distance ------------------------------Width of trench------------------ ---------------- N) <br /> Number of lines.:----------------------------------Length of each I'me ofa� length------------------------------------------ N <br /> El �terial_-----------------------Depth of filter maferla4-----------------------T dF <br /> Type of filter m foundation-- 15.u., nearest lot line--.9- --------- <br /> e.'" ___.Di t ce to <br /> I est well- /Yj_47t_L­'Di5�ance from found ----------- ep*__02x_I - <br /> a ----------D ------------------ <br /> Seepage Pit: Distance to near 3 <br /> Lining materiaLl <br /> • <br /> ,-Size: Diam ter <br /> Number of pits---6YV--------Li n --------------------Lining ma+erial------------------------------------ <br /> )K Distance from nearest wail-_-------------Distance from foundation Capacity----------------------------gals. <br /> ti Cesspool' Size: Diameter------------------------ ---------Depth----------------------------------------------------Liquid <br /> D Distance from nearest building---------*-------------------------------- <br /> Privy-. Distance from nearest well------------------------------------------------- -----------I--------------------------------------------------------------------------- <br /> El Distance to nearest lot line-. ------------ -------------------- --------------- <br /> ------------------ --------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)------ - ---------- -- ----------------- ---------------------------------------- <br /> ------------------------------------------ --------------------------------------------------- -------I-------------- <br /> -------------------I----------- �4&14-- -------------------------------------------------------------I------------- ------ <br /> -----------------------------------------------------------•-------- -----------------I-------------- - -------------------------------------------------------------------- <br /> -------------------- -------------------------------------------- <br /> -------------------- ----------------------- <br /> -------------------------------- d this-application and that the work will be done in accordance with San Joaquin County <br /> I hereby certify that I have pre a a <br /> acid egulaflons of the San Joa7y, Local Health District. <br /> 7-/l Contractor) <br /> ordinances, State laws, and rules - --(Ownerqn or <br /> T <br /> tA---- _Y_ v------ ----------------- <br /> (Signed)---------- ----74' ifle)--------- ------ - --------------- <br /> -- --=---------- <br /> - ----------- - - -- -- - - - - ------------- <br /> --------------- <br /> By:------------------------ in relation to ells, buildings, etc., can be place4 on reverse side). <br /> (Plot plan. showing size 0 lot, location of system FOR DEPARTMENT USE ONLY <br /> ► --------------------------- DATE ----------------------------------------------------- <br /> APPLICATION ACCEPTED BY--- ------- -------- ------------------------------ DATE----77;k-- - ----------------------------------- <br /> ----------- ----- <br /> 4T, --- __------------------------- ----------------------------------------- <br /> REVIEWEDBY-----.------------------------- ------------------------------------------------------------------------------ DATE---------qS\ <br /> BUILDINGPERMIT ISSUED__.---------- --------------- ------------------------------------ ------------------------- ------ ----------------- <br /> Alterations and/or recommendations--------------------- ----------- -------------------------------------------- ---------------- <br /> --------------------------------- ------ -------------------------------------------------------------- ---------------------- --------------------------------------------------------------- ------ <br /> ------------------------------------------------------------------ ------------------- ---- ---------------------- ----------------- <br /> --------------------------------------------------- <br /> - -------------------------------- ----------------------------------- . <br /> -------------- ------------------------------------------------------------------------ --------------------------- ---------------------------------------- <br /> - ----- -------------I------- ------------------ --------------------------------------------- -- ------------ -------------------------- <br /> --------------------------------- <br /> ----------------------- <br /> Date --- : - _0 - -- <br /> FINAL INSPECTION BY..r?4 __/Z.....o/—— ------------------- ---------7 V <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street <br /> 300 West Oak Street 132 Sycamore Street Tracy, California <br /> 130 South American Street Lodi, California Manteca, California <br /> Stockton, California <br /> E5-9-2M B-51 Revised W-2100 <br />