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APPLICATION FOR SANITATION PERMIT Permit No. -.. 1p------ <br /> (Complete in Duplicate) Date Issued /;011/� ---- <br /> Applical-ion is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> -OCATION.-A/96 e;?r:7tr--. <br /> L <br /> JOB ADDRESS AND <br /> ------------------------------ <br /> Owner's Name-----_-- <br /> 2,10/em --------- ---- --- <br /> Address-----------__------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> "V e, �� <br /> Contractor's Name-------- ------_.r1k - ------ Phone-------------- -------------------- <br /> Installation will serve: Residence [Apartment House E] Commercial [_1 Trailer Court E] Motel [] Other [_1 <br /> Number of living units: __/---- Number of bedrooms Number of baths -A.- Lot size --- -- ---•---`---------------------------••-- <br /> Water Supply: Public system 0' Community system [I Private [ Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [] Sandy Loam El Clay Loam El Clay �Adobe ❑ Hardpan E] <br /> Previous Application Made: Yes n No gj�New Construction-. Yes ��No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> on--JA- ------Material------ --------- ---t-6-4- <br /> Septic Tank: Distance from nearest well__n�_4 -----Distance f 0 fo'undati <br /> Iwdepth_.._"" /------- - <br /> No. of comparfments_ ---- -------- -----Liquid Capacity----- <br /> ----- <br /> Disposal Field: Distance from nearest well--y4fe....-Disfance from founclafion__,.41 --------- Distance to nearest l10Y <br /> ot line----8�-------- <br /> Number of lines.------- tengfh of each line_____._...........-Vidth of french.....a_y--------- <br /> Type of filter material--/,.. Depth of filter material-..../ -_!____Total length <br /> __.Yr-------- Dj'sf- nce to nearest lotline------------- <br /> Seepage Pit: Distance-to nearest well____-- Distance from founplafion ...... -------------- <br /> 91 Number of pits.----jq-------------Lining maferiaI_e_,6._,#0,/r1.4Aize: Diameter------------- .... Depfk <br /> Cesspool: Distance from nearest weil--------_------Distance from foundation... ---------------rLining material_____________________________________. <br /> ❑ <br /> aterial-------- ---------------------------- <br /> 0 Size: Diameter----------------- -------- -- --------Depth----------------------------------------------------Liquid Capacity_-------------------------gals. <br /> Privy- Distance from nearest well--------------------------------------------------D�stance from nearest building---------------------------- <br /> ❑ Distance to nearest lot line--------- ------- ...... ------------------­------I-------------------------------------------------------------------------------- <br /> Remodeling and/or repairing <br /> ------------------------ (describe):- -----6W4 1 ---- � <br /> ----------- <br /> - ­ ---------­------------------------------------- <br /> -----------------------------------------------------­_­---------------------­--------------------------------------------------..................................----------------------------------- <br /> ------------------------------------ ---------------------------------------------------------------------­-­--------------------------------------------------- ------------------------------- -------------------- <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, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------_------------------------------------------------------------ ------------------------------------------------------ ...........--""-""-"""""-•-------- -.(Owner and/or Contractor) <br /> By:.......... --------------------------------------------- ---------------------------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be,placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- <br /> BY-- ----•----------- ••------------- DATE----- ----------------------------------------- <br /> REVIEWED BY------------------------------------ -------- <br /> ------------------------------------ DATE_------- <br /> -----------------------......------ <br /> BUILDINGPERMIT ISSUED-------------------------------------- ------------ ---------------------------------- DATE......... . ----------------------------------- <br /> ...... d� <br /> Alterations and/or recommendations:----------------- ------ - --------------------- --------------------------- ----­------------------- <br /> -;;;;-------a.10 ----------- ------------------ -------------------- <br /> ----------------- ---- ------ - <br /> ---------------------------------------------------------- <br /> - -----------T ------------------- - ------- -------- ----------------------------------- <br /> -------------- --- ---�A--------K----- <br /> ----------------- <br /> ­---------------------- ------- --------------I-------------------- ------------ ------------------ -- ----------------------------- <br /> ------------ ------ ----------------------------------- ----- ----------------- -"------- <br /> -- ------------------------- ----------------------- ---------------------------- --------:---------- <br /> ,-- I , --- --------------------- <br /> ------ ----- <br /> -)--- ------- -- <br /> FINAL INSPECTION BY:--"""--- ........... --------------- .................. Date- <br /> 1 , SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lod;, California Manteca, California Tracy, California <br /> E S___9 145445 ATWonD <br />