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APPLICATION FOR SANITATION PERMIT Permit NoA-33J <br /> --- <br /> (Complete in Duplicate) Date Issued �/ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal[the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION----..10-4p ------ij---------------------------------------------------------------- ---------------- <br /> P Z <br /> Owner's Name------------------------------------------- -------V , -------­­----------------------------------------- Phone...................77-_ <br /> Adclress-._............--------------------........j_4q__2-V__ —---------------------------------------------------------------------------------------------------- <br /> 3F_",v 7 <br /> Contractor's N6me--. ........ '_44 w?"AUX-Al!------------------ ----------------- Phone_ ------------- <br /> Installation will serve: Residence X Apartment House E] Commercial F1 Trailer Court E] Motel [] Other El <br /> Number of living units: _--Number of bedrooms _/--- Number of baths -/---- Lot size --—------------------------------ <br /> Wafer Supply: Public system Community system F1 Private E:1 Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel [] Sandy Loam El Clay Loam 0 Clay E] Adobe& Hardpan E] <br /> Previous Application Made: Yes E] Noj!�, New Construction: Yes P(.,No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public <br /> - ewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest weq-174- ------Diestancfrot'fo clafion/0_7�40-------Material--- <br /> -- <br /> v . --­_/----- ---- -- <br /> ----- -------- <br /> ................Siz _77------------- ----Capacify,0 <br /> No. of compartments----- Liquid depth 4, <br /> Disposal Field: Distance from nearest well-119)UJ-_Disfarice from foundation--)#-----------Distance to nearest lot line_________________ <br /> Number <br /> ine----- <br /> Number of lines-----f--------- Length of each line----2-V-* Width of trench----1411-V I a,---------------- <br /> X_4 4-0 0-j---------- --- 0 <br /> si <br /> Type of filter --------Depth of filter material-_--_- length-Ap----------- <br /> -------------------- <br /> Seepage Pit: Distance to nearest well-t.2490-------___Distant fo ndat'on_*2?-----------Distance to nearest lin----------17""' <br /> 54 Number of pits--------I------------Lining ma _f fro <br /> 4T --- Size: Diameter--a-3----- Depth----4--P-------------------- <br /> Cesspool: Distance from nearest well----------------Disfance from foundation__----_-_---_-----_Lining Lining material--------------------------------- <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------ga S. <br /> Privy: Distance from nearest well--------------------- ---------------------------Distance from neat-e&t building___---------_____-_______________________-- <br /> ❑ Distance <br /> uilding------------------------------------------- <br /> Distanceto nearest lot line--------- -----------------------------------_-----------------------------------------°----------------------------------------------------- <br /> Remodeling <br /> ---- t----------------------------------------------------- <br /> Remodeling and/or repairing [describe):-------------------------------------------------------------------------------------------------------------------------------- -------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------­---------------------------------------------------------------------- <br /> ---------------•-------------I-------------------------------------------­----------I----­-------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, rules and regul * s Of +he an Joaquin Local Health District. <br /> 11 A <br /> (Signed)--- AJ - <br /> --- --- --------------------------------------------------- (QwPePAxdpiPr Contractor) <br /> CTJ 6 (Title)-- <br /> By:---- --- 1A <br /> -- ----- -- ----- - -- -- --- - ----- -- -- ------ ------------- ------ (Ti+le) <br /> `;ysf_e­m­_in__re_1­a_fion__f­o`_wells,-_6uiIdin_gs_,_-etc.,--can be placed on reverse side). <br /> (Plot plan, s wing size of loft <br /> 4w, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- -------------------------------- DATE------------------------------------------------------------ <br /> ---- <br /> ?- <br /> REVIEWED BY------------------------------------ -------------------------------- DATE ----- - __------------------- <br /> BUILDING PERMIT ISSUED------------Z-------------I----------t-------------------------------------------------------------- DATE-------- <br /> ----------- ----------------------------- <br /> Alterations and/or recom mend a tion s:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------- -- -------------------- ------------------------------------------------------------------------------------------­------------------- <br /> ---------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------- ---------- ------ ------------------------------- -------------------------- - ------------------------------------ ------------------------------------------- <br /> FINAL INSPECTION BY:-- - -- ------------- Date. A j4s-z----------------------------------------- <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sfreat 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />