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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued ...I <br /> leApplical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein )escribed. <br /> This application is made in complianceCounty?;i ae N 9__ 1 .11 <br /> pig Ordinance N 9. 'r <br /> ------------------- <br /> .... .... ......... <br /> JOB ADDRESS AND LOC N.. -------- ------ ---- --- ----- ----------- -- ----------- ff- <br /> ....... .. . ............ .9 <br /> --------------------- Phone----------------- .................. <br /> -------- --- ----------------- --- <br /> Owner's Name- 6 <br /> Address--------• -------------- ------------- ----------- <br /> PhoneContractor's Name . ------------------------------- <br /> Motel E] Other I- <br /> Installation will serve: Residence 4-A-PIrtment House ❑ Commercial E] Trailer Court 0 <br /> Number of living units: Number of bedrooms �_ Number of baths .1--- Lot size ---- ------------- <br /> Water Supply: Public system [3 Community system [I Private epth to Water Table Soft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam E] Clay Loam E] Clay E] Adobe 6-91-1dPan El <br /> Previous Application Made: Yes [] No kP­ITe_w Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> W <br /> V <br /> ------------ <br /> Septic Tank: Distance from nearest well_ Distance from foundatio------40------Material---- ----- ------------------------ <br /> C�_ No. of compartment--------- Size-----t_�-----K_Q---.. <br /> IJ-Liquid --- ----------Capacity----8 1-Y-0--- 1� <br /> Disposal Field: Distance from nearest well___.�15---0_Distance from foundation-___ ......Distance to nearest lot line.-115._-.1.--- <br /> Number <br /> ine.-115 -.1---- <br /> Number of lines.-.-_---1 Length of each line--_---. ' -----.Width of trench__2n%4-`--_--_------------- 7- <br /> r <br /> Type oT filter material---/ --..-_._.-.-Depth of filter material--_- _---..Total length---,- ----------------- IV <br /> yr <br /> V, <br /> Seepage Pit: Distance to nearest well--la-P-------Distance hom_107 clation---_-?U_!_.Distance to nearest lot line- <br /> -_ .size: Diameter.--- <br /> Number of pits.--/---------------Lining _ --?3...... Depth <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material- - --------- - --------------------- <br /> ❑ Size: Diameter------------------- ------------------Depth---------------------------------_----- - -------Liquid Capacity----------------------------gals..10 <br /> Privy- Distance from nearest well_ ..-.----._..--------_----------------Distance from nearest building.-_.__---_____---- _--.-------I........ <br /> ElDistance to nearest lot line-------- ------------------------------------ -----------------------------I---------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):-------------------------------------------------•- ----------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------­­I------------------ <br /> ----------------------------------------1---------------------------------------------------------------------------------------------- ------11------------------------------------------------------------------------I— <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that +he'work will be done in accordance with San Joaquin County <br /> ordinances, Stlaan ides a d regulations of the San Joaquin Local Health District. ................ <br /> ..... <br /> ---------------- ---------------------------------------------------------------------- <br /> (Signed)...---- ----- (Owner and/or Contractor] <br /> By:.---- -- --------------------------------I--------------------------------------(Title)--------I -------- -------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to W611s, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------------------------1�--- -- ---------------------------------------------------- DATE----------_._ -------------------------------------------- <br /> REVIEWEDBY------------------ ------- --------------- -- --------- -- -------------------- --------------------------- -------- DATE-------- ---.7------------------------------------------- <br /> BUILDING <br /> -7.97-------------------------------------------- <br /> .. ........ <br /> ------- DATE-----I------------1%--- ------------------------------------ <br /> BUILDING PERMIT ISSUED------------------------------------- .............. --------------------------- <br /> Alterations and/or recommendations:------- ------------------ - ­ ------------------------------------- <br /> --------------------------------------------------------------*--------*­ <br /> ------------------------------------------------------ -------­----------------- <br /> -------------------------- ----------------------------- ----------- --- -------------- -- <br /> ----------------------------------------I--------- --------------------------------- <br /> ------------------------- - - ---------------------- <br /> ---- --------- --- <br /> c. ---rb---- -- -- -- <br /> ---------------------------­ __-- ------------------------------------------- ----------- --- ----- --------------------- ----------------- -------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------- --------------- -- -------------------­ ­---------------------------------------------- -------------- <br /> -2-Z--,I <br /> FINALINSPECTION --------------------- ------------- 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 /> ES­9-2-M 145446 ATWUDD 12-54 <br />