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' ^ APPLICATION FOR SANITATION PERMIT Permit N � �omm�fm �n �uo�cafm ' k ~ ` Duplicate) Date |ounJ ----------------------- Application is hereby made to the San Joaquin Local Health Distr|cf for u permit to construct and install the work herein described. � This application is made in compliance with County Ordinance No. 549. | ^ /�� z1-7-Y� / JOB ADDRESS AND N.---��^r..z,-_--.��'1��=-x..�4-.t'_c^��----------------------------------------------_---.----_.--_-. C)wnor'o Name--------�'� -�� '----' ----.------------------.--.--- Phone- ��.°�/ 3.5�j-.. , A66mou-'_-------- `---_---_.---'--_----___--'-.--_------_-----_----- ------------------------------------- Contractor's -_-.------.-_-----Contra. s Nome------F� .�l, �- ��-��..� w/.�_-__-.__-_-_-_---_-- Pkcm- ;J f---- Installation Installation w0 serve: Residence Apartment House 0 Commercial [] Trailer Court 0 Motel 0 Other E] ` ^ Number ofliving units: Number vfbedrooms Number of baths -Z.. Lot size ~Iy-__--_-_' Wafer Supply: Public system Community system -El Private F-] Depth to Water Table __ ft. Character nfsoil to depth of feet: Sand E] Gravel [] Sandy Loam L] Clay Loam Clay E] A6o6ed7l Hardpan ' Previous Application Made: Yo, [] No New Yu,T�� No . TYPE OF INSTALLATION AND SPEC;|p|CAT|ONS: / (No septic tank orcesspool permitted if public sewer is m°aUmb|e within 200 feet.) . ' SopficTank: Distance from nearest well-----------------Distance f,o�hfoun6otion--------------------Mu+erioL----_----_-.-_-_-.- El No. of compartments--------------------------Size--_-.-----..-.--Li�uid d�pfh---------Copo�i+y.-------- .�� . . � Disposal Field: Distance from nooroo well .oL-----Distanca from foundation--------------------Distance to noo, eo lot |in �k E] Number of Ones-- Length of each line------------ _ Width of trench-'--__.''_-'-'- Tvoa of filter material-------------------------Depth of filter hootvrinL--_---Jnto| length------------------------------------------ x�_ � � Seepage Pit: Distance fn nearest *ei'-'''-- �/O�' ANumber of pits-------/-------------Lining material Diamefer-,�3_4.�.�-.Denfh-_°1.,5-- ------------ Cesspool: _-- : Distance from nearest well----------------- from foundm+ion -'�'�_-��!Lining mn+oria|--'''-_-'---__.-- [] Size: Diameter. ---------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. ' Privy: Distance from nonna� weL---'---'''''-_'''--'D�+unco fnm, noora,t6u36�g_��__._____.-_-- ` El Distance to nearest lot line-'-_---._-.------_._-_-_---__---_.___-'_-_----_ ' Remo6eling and/or repairing (describe):-_-. ---'___---__--______._________ . __-________-____.____'---____-..___.--__.__--��..___-_,-_.-___.-___'__---__--____ v ` -__._--__----______'___'_.___'_-_________-__-____-____--__.___---_--_--.--'-_-_''_' � ----_--'__..____~---__-._----------.-..-'.-.-_-..'--_--_-_'--_.------------.--,-_..-----_-----_-_.`_-.-.. ` I' ' ' hmv6 'prepared This that the work will be done in accordance with San Joaquin County ordinances,�State laws, 6 � i and regulations of the S n Joaquin Local Health District. ' size of of, location sy (Plot plan, showing stem in relation to wells, buildings. etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPT'P'6 BY------------- D ;----------A REVIEWED BY ATE ' -'''-_----'-''-''-''''''--------- DATE---------------------------- ''--''_______Alter tionsmnd/ _ -'''-_''---__--''--__'`''-'-'---'-'__--___--__-.____. -'--'-__.'-__' --_-'`_--- -''-'-_-'---__.''''-_.'''''--'--'--'''__-'-__-'___-_____ --___-------.-.--~_--`-----'---I------ -------.------------_-----_------------.-----'`----_-.-- __-_-._-___-.-^_-_-+..`�--^-----_-----_--'__--_---_--_---`--_-._._---_ . --'-''-----_-''---''''----'''---''�'�,---'-��-��'-�-''''''-'��''��'-�'�'-�'''`-''','''''---.-----'---- � /��' F|N/\L INSPECTION 8y---_-��-�..��_.--_-----. Do�,--..j��. ------.----� � wp � SAN JOAQU|NLOCAL HEALTH DISTRICT / /ao South American Street 30D West Oak Street oz Sycamore Streex/w North "C" Street ) Stockton, California Lodi, California Manteca, California Tracy, California U ES-9-2M 8-51 nv.is86 *-2100 � U ��