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Permit No- --- - -------------- <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued --?/±jj <br /> 0 co t and 'install+h6 work herein described, <br /> Appli I ca-lion is hereby made to the Sari Joaquin Local Health District for a permi <br /> This application is made in compliance with Coijn P fy Ordinance No. 549. **S1 <br /> 3-------0 - �0 ------- <br /> ---------------------- <br /> - <br /> JOB ADDRESS AND LOCATION___,9?J1_j,1V---------- ---We,11-j - Phone------------------------------------ <br /> Owner's Name_/ - - -------- ------------------------------ -------------------- <br /> -C,-4 h-t, ------------------------­----- <br /> Address-.----- ------ ------ �------------------------ ---------•--•--------•---•-------•--• <br /> ------------ <br /> Phone_ <br /> - ------------------ <br /> Contractor's <br /> Name------------- ,..0V [3 <br /> Installation will serve: ,Residence$. Apartment House [I Commercial El Trailer Court E] Motel -------------- <br /> Number of living units: --- ---- Number of bedrooms,-V---'Number of baths 1____-_ Lot size .........;�--- <br /> o Water Table -------- ft. <br /> Community system d Private E] Depth f I . <br /> Wafer Supply: Public system , ravel F1 Sandy Loam 0 Clay Loam El Clay E] AdobeA -Hardpan <br /> Character of soil to a depth of 3 feed: Sand [I <br /> Previous Application Made: Yes No 0, New Construction: Yes, No F1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No septic tank or cesspool Permitted if public sewer is available within 200 feet.) <br /> ia4------------------------------------------------ <br /> Distance from.om nearest well___-_ from foundalion--j-10---------Mater <br /> Septic Tank: 77 31-Liquid depth-------y----------------Capacity----- <br /> o. of compartments--;?- SizeJ---- ------ <br /> N <br /> ---Distance from foundation____,3.jF_-_'L-----Distance .to nearest lot line <br /> Distance from nearest w -.Width of trench.'--- <br /> Disposal Field: Number of lines------ 1;2 ------Le* ngth 6f each Ii 1�?_-X;__-----•--------•---- <br /> _.;1-------------- <br /> _7�!,----Total length-------/---51-7---- <br /> Dep0of filter material----/ <br /> Type of filter mat -- ------- - <br /> T Disfanci to nearest lot line----------------- <br /> Deptn--------------------------------- <br /> Seepage Pit: D;stance to nearest well------------- -------Distance from foundation ----------------------- <br /> _: Size: Diameter <br /> Number of pits.'----- -------------_Lining material I <br /> Elining maferiail------------------------ <br /> from foundation--------- ----------L <br /> Distance from nearest well-----------------Distance . f .? I Liqyid Capacity_________________----- <br /> ❑Cesspool ---------Depth........ ------------------I------- ------- ------ <br /> Size: Diameter--------------------------- <br /> "Distance from nearest weh-_-----------------------------I------------ ---Distance from nearest building----------------------------------------- <br /> Privy: - <br /> Distance-to <br /> - -------Dis tance-fo nearest1 0 <br /> lot line--------------------------------------------- ---------------------------------- -repairing [des(:6�3ej:---- t, <br /> Rerr�odeling and/or -•P------------------------------ <br /> ------------------------------------- <br /> ax <br /> - - ---------------------------- <br /> ------------------------------------------------------------- -.1---------------------------------------------------- ---------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------- accordance with San Joaquin Courity <br /> re orad this application and that the work will done in a <br /> I hereby certify that I have p`__p_____ <br /> d regulations of the San Joaquin Local Health District. <br /> ordinances, State laws.: and rules an --(Owner and/or Contractor) <br /> ------------------------------------------------------------------- <br /> (Signed)- yL <br /> ----------- ----- ----- ---------------------------(Title)- --- 1!5 _r-------------------------------------------- <br /> lay---------- dings, etc., can be placed on reverse side). <br /> (Plot P1 in. shog size of lot, location of ystem in relation }a wells, <br /> FOR DEPARTMENT USE ONLY <br /> DATE------------------jj-;�o­ ----------------- <br /> APPLICATION ACCEPTED BY------ DATE-----3- --------------- 2l-----------•------- <br /> 1 REVIEWED BY----------- - ------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------•----- ----------- -- ----------------------------------------------------------------- <br /> recommendations-.- _____" . <br /> -` <br /> and/or ---------------------------------------------------------------------•----------- <br /> J <br /> ----------------------------------------------I------------ -- --- ------ <br /> - ------------ <br /> - ---------------------------------------------------------%-. ------ . r .I) I ----------------I---------------------------------------- ------------------ <br /> 7 �,o ----- -------------------------------- <br /> _4 --- -------------- _­ % <br /> ---------- -------- ----------------------------I . i V ,__i-L --- - __- <br /> -----I - <br /> - ------- ------------------------------------------------------------- __-..-•--_•----'----_--------------------- <br /> -------------------------------------------- ---- ------­ __.- ".- � . . .- ( ----------------- ------------- ------ --------- -----------------I--------- <br /> I I'l _1- -- ------ - ------ <br /> -------------------------------------------- -------C ___ .- ----- <br /> I <br /> L <br /> Date--- ----------------------------------- --------- ---------- ­------------- <br /> - -- --------------------- <br /> FINAL INSPECTION BY:____------------------- 13 <br /> SA JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street Tracy, California <br /> Stockton, California Lodi, California Manteca, California <br /> cc v_'AA Revised W-2100 <br />