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APPLICATION FOR SANITATION PERMIT Permit No. 6............. <br /> (Complete in Duplicate) Date Issued <br /> Applica41on is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This applicafion:is made-in compliance with County Ordinance No, 549. !?Z-3-$ <br /> LQi 0S_j-t I I f <br /> 0, <br /> U, <br /> JOB ADDRESS AND LC_ ATIO f_g <br /> RPh ne----------------------------------- <br /> Owne'r's Name-------- ---------- /------ ---------- --- 6,�Z <br /> 19----- --- /V—--------------------------------- ---------------I---------- <br /> ----------- <br /> Address-....-------------------- --------------------------0i Phone2i(�97 <br /> Contractor's Name---- -- -------------------------------------------------------------------------- <br /> Installation will serve: Residence F1 Apartment House El Commercial pq, Trailer Court El I Motel E] Other [I <br /> ........... <br /> Number of living units: _jr�Number of bedrooms -7--T=Number of baths _I_____ Lot size _,z_ACA ------------------------ <br /> Water Supply: Public system [] Community system E] Private K Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam El Clay Loam El Clay 0 AdobeN[ Hardpan 0 <br /> Previous Application Made: Yes E] No 01 New Construction: Yes El No K <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) <br /> , (No septic tank or cesspool permitted if public sewer is <br /> Septic Tank:,r/A(G Distance from nearest well_____ ______- Distance from foundation-------------------- Capacity..- <br /> ��Aaterial------------------------------------------------- <br /> Size--------------------------------Liquid depth_ --------- --------------------- <br /> E] j5' No. of compartments-.---- .----1, 0 <br /> 757 lot line__Ano... <br /> Disposal Field: Distance from nearest well --Distance from foundation__----- _t____.Distance to nearest <br /> _4_ <br /> Number of lines---to—M ,r---------------Length of each line__ Width of trench_-_ ­-------------------- <br /> Type of filter material Depth of filter --Total Iengfh____-:5_e---I------------------------ %.A <br /> Seepage Pit: Distance to nearest .____._Distance from foundation_ ;140--------Distance to nearest I t I ne <br /> -:Size: D ------- e __.4-—------------------ <br /> Number of pits.- _--.---Liningiameter_____3Z.... D pthU <br /> 'material- <br /> istance from nearest well-----------------Distance from foundation--------------------Lining material_----_---._.________-_._--_-__-_____. IE <br /> Cesspool: D ----------Depth-------------------------------- ---------------------Liquid Capacity----------------------------gals.C;F <br /> E1 Size: Diameter-------------------------- <br /> Privy: Distance from nearest well_______________________._ .--------------- ----Distance from nearesf building-________"._"___________.----------------. <br />�I <br /> ❑ - Distance <br /> uilding---------------------------------------- <br /> Distance to nearest lot line--------------------- ------------------ --------------------------------------------------------------------- <br /> ------- -- -------- <br /> Remodeling and/or repairing (describe]:--- •---------------------------------------- <br /> ------------------------------------------------ -A­ <br /> AW 40---------- <br /> ------------ -----------I---------------------- ----------------- _G... ... <br /> ----- ------------ ------------------------------------------------------- <br /> ---------------------------------------------------------- ----------- <br /> ------------ <br /> ----------------------------------------------------------------------------------------------------- -------------------------------------------- -------------------------------- <br /> ---------I hereby­certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sfa aws, nd rules and regulations of the San Joaquin Local Health District. <br /> ) ip - 7-------------------------------- -------(Owner and/or Contractor) <br /> (Signed 4- --------�ZILV_�------------------ <br /> 7ws� 4 - --- --------------------- ------- <br /> By:--------- ------ --------- -----------------(Title) ---------------------------------- <br /> in wells, buildings, etc.. can be placed on reverse side). <br /> -(Plot plan, showing size of lot, location of system in relafio <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- -- ---------- V & ----------- DATE------------ <br /> -------------- <br /> - <br /> REVIEWEDBY-------------------------- ---------------- -------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------ ----------------------------------------------------- ----------------- DATE----------------------------- ------------------------------ <br /> Alterations and/or recommendations:--------------------- ------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------I----------------------------------------------- ----------------- ----------------- -------------------------------------I--------------------­­----------------------- <br /> --------------------------------------------------------I----------------- - ---------------------------------------------------------------------- ------------------------------------------------------------------- ------ <br /> ---I--------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- <br /> ----------------- ---- ------------ ----------I--------------- ---- --------------------------------- -­------------------------------ ------------------------------------------- ---------- --------------------- <br /> FINAL INSPECTION BY------------- -------------------- --------------------- 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 /> ES-9-2M Revised W-2100 <br />