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ti <br /> APPLICATION FOR SANITATION PERMIT Permit No. ---- -- -- ------- <br /> (Complete in Duplicate) Date Issued -I- <br /> Applica�ion is hereby made <br /> e to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made:in compliance <br /> liance with County Ordinance No. 549. <br /> ---------- <br /> JOB ADDRESS AND ILOCATIO ---------------------------- ------- <br /> 761 .... Phor.Zr <br /> ---------- <br /> ------------------------------------------------ <br /> ka'sle-M------------- ------ <br /> Owne <br /> Owner's Name--:_... � - - . 7 1 ­ I <br /> Address-------------------- ---------------------Sam -------------i-----------------------I----------------------•--------------------------•--------- <br /> ---- Ph <br /> ------------- <br /> Contractor's" Name------------------------------------------ ----------- -------I------------------------------- one - -- ------i- <br /> Installafion'w4l serve: 'R' 'de,'co Apartment House C] Commercial E] Trailer Court [] Motel 0 Other E] <br /> "0 1 <br /> Number of living*uncf5:',-i---- Num' ber of bedrooms J---- Number of baths A---- Lot size ___/X-VA------V-41P---------------------- <br /> 1. '01 t o <br /> Water Supply: Public system jC <br /> em' --Commufiif-y [I system ' Private E] Depth to Water Table <br /> 4-tf I. <br /> Character <br /> r of soil to a depth 0 f 3 feet: Sand E] Gravel ❑ Sandy Loam El Clay Loam ❑ Clay 0 Adobe*X Hardpan E] <br /> Previous Application Made: Yes [-I No If—New-Construction: Yes,X. No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic'faW or c6sipool permitted if public sewer is available-within. 200 feet.) <br /> aferial--- ---------- ---------- <br /> Distance from n(.;,*.,t w7p� ll*. ff__'��Dist_�`nce fromfoundlation_ <br /> Septic Tank: <br /> x : <br /> I ---------- S i z a 11111111MUT"Aft ---Liquid depjhAC_6---•------------Ca`pacify_of_ <br /> No.,of.comp;arfmen Is_.-J <br /> 1 -1 . . 1 '6r 4P <br /> Disposal Field:' iDisfanc-e from' ne' _t well "-#_Vstanc?rro`M` founclai 10' Distance to nearest lot line_% -------- <br /> _ys�r we Aw--:-; <br /> N u1mbe"r,0"i,lines _______--Length of each hne____M.V----- `_Width of french- 00!--__---_________ <br /> ..of filter maferiaLd"If-----------Total length_________________S. ------------- <br /> Type of filter material ----:Dept� I S. 0 <br /> e--- <br /> -Lininj ter '-.Size: Diameter.__,3_4-------Depth-'.Z_4*_ <br /> Number of <br /> e Pity. <br /> . 1' -�� j' r'kftdt_7'_D�;f f- f �cl�f OnAiV!.......Dist�nce to nearest lot ]in <br /> Seepa Distance o n;arest;i.�ell_� ancq from Qu ------- <br /> ma ----------- <br /> ' D;sfance from nearest-w-elI____, ------------------------- <br /> Cesspool: well-----------------Distance from foundation----_---____------------ Lining material--------- <br /> El- S izee:-Dia mef6 r I---------------- ----- `Depfh-----------------------------------------------t----Liquid Capa6.ity- _-------------------------gals. <br /> Privy: Distance from nearest -------"'-----------------------Distance from nearest building------------------------------------------- <br /> Distance to n'ea`rest,lot iine_--_--- --------------------------------- ---------------------------------------------------------------------- <br /> El - ----------------- ----------- <br /> Remodeling and/or rep6irin4 (describe):----- <br /> w---------------------------------------------- <br /> --------------------------------------- -----------:-------------- <br /> -----------U---0------2yliled of- <br /> --------t7evil $- ------- -- - ----- ----------- <br /> -- <br /> f -------------- <br /> ------------- ---------........ --- <br /> ------------------------------------------------------------7-j----------------------- T <br /> I -------------------------------------------------------------------------------- <br /> ------------------------------------- ------------------------------------------1-----------------__--------------------------- <br /> --------- <br /> I hereby certif prepared 7o-n-a'N that the wor)Wwill be done in accordance with-San'Joaquin County <br /> "a� �v Pared this icati <br /> ordinances. State I- sl and 61:s anal ' gulatto of the��aJojiggW,.Irdfla +lealth District. <br /> /S ..--- <br /> r <br /> t - ------ C� -------------------------;....... 6- -Contractor) <br /> ---00 ----------- --------- ....... .... <br /> (Signed)-------•-- <br /> -------------------­----- -- i-------------------- --------- ----------- ----- --------------(Title)- Ole <br /> (Plot plan, showing size I of lot, location of.system i rel n. o.we I Is, 6uildi s. etc., can be placed on reverse side). <br /> FOR DEPARTMENT.USE ONLY. <br /> APPLICATION ACCEPTED BY------------- -------- ------ - -------------------------- --------------------------- DATE-------------- -----­----------- <br /> �r- --------/------------- <br /> REVIEWEDBY----------------------------------- ------------------------------- -----------------=----- ------;:------------------ DATE----------- -------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------- -------------=-----=--•----=------------"--------- DATE-------------------------- --------------------------- <br /> Alterationsand/or-recommendations--------------------------------------------------------------------- ------------------------------------------------------------------------------------------- <br /> ----------------­-------------------------------------------------- <br /> ------------------------------------------------- ----------------- --------------------------------------------- ---------------------- ----------- <br /> ---------­---------- ----------------------------------- ......-------------- <br /> ------------------------------------------------------------------------------ --------------------------------------------- --- <br /> ----------- <br /> ----------------I-----------------------­---------------------..........--------------------------i---------- <br /> -------------------------------------------- ---- ---------------- ------------------------------- <br /> ---------- --------------------------- ------------------------:----------I----------------------------------------------I------------------------------- <br /> 7 <br /> -------------------­--------------------- ------ - ---------- <br /> 2-i5f A <br /> FINAL---INSPECTION BY::-------- ------- ------- Date----------------=-- . . - <br /> SAN <br /> ate----------------------------------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 />