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APPLICATION FOR SANITATION PERMIT Permit No. .�,-F-V7 (Complete in Duplicate) Date Issued A lica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. /�p p ri clz This application is made in compliance with CounfyQxJ�nance No. 549. 7 JOB ADDRESS AND LO�CVATION--- ------ZZ ---- ............. ---_------- ---------------------------------- ---------------- Phole/i/k Owner's Name --- 7!-------- Address----------------------- ------ .......... -------------------------------------------------------------------------------------- --------------- Contractor's Name.__--.. ------- 7 Cr------------------------------------------------------------ Phone-- e Installation will serve: Resid nce Apartment House L] Commercial L] Trailer Court [] Motel ❑ Other ❑ ff Number of living unitsl: I---- Number of bedrooms I-'- Number of baths I--- Lot size ---- ------- Water Supply: Public sysferfi K Com'munity system E] Private Ej Depth to Water Table -------- ft. Character of soil to a depth I Of 3 fee+: Sand E]. Gravel [] Sandy Loam El Clay Loam E] Clay ❑ Adobe)( Hardpan E] J Previous Application Made: .,Yes E] NoKNew Construction-.: Yes No R k. . TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if @ublic sewer is available within 200 fee+.) Septic Tank: Distance4rom nearest well C-11C,------ fir! -- ------- t��__Disfanc`e from-foundati n ------------Material--- No. of c8'mparfments_..Z_.__.------------I Size. Liquid dep�h_.-,Tbo'...............C8pacify__XV0____ 'OA%' rom Tf Disposal Field: Distance from nearest wefi.�GjuL,)__Distance ndafion_jf-:�7-------Distance to nearest lot line__ ----------- Number of lines--- --Length of each line__,%_&'� ---Width of ----------------- 0-f---------------------- ----------4-------- Type of filter material_ '. _1112�_-_Depth of filter material-- _Total length----- � - - an Seepage Pit: Distance Ao neare f -q-0-1-----_Distant c f- ounclation-j-9.'4-------Disfance to nearest lot line--- we ------ Off Number of pits-- -----------------Lin maferia I Size: Diameter-Z-5---- Depf hS.X!�------ i�. J.ric; "4_'_.Size: ------------ Cesspool: Distance from nearest weJ--------------_Distance from foundation--------------------Lining material__-_____---__----_----__-_____-___-__. ❑ aterial------------------------------------- F1 Size: Diameter--------------------------------------Depth --------------------------------------------------Liquid Capacity----------------------------gals. Privy: Disfance,4rom nearest well-------------------------------------------------Distance from nearest building----------------------------------------- Distance'fo nearest"lot-line------------------------- - --------------------•--------------------- Remodeling and/or repairing (describe):--------- ------ --------------------------------------------• ••----------------•:•-=-------- --------------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------ -------------------------------------------------------------------- ------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------:------------------------- ------------------------------------ -------------------------- ----------------------------------------------- ------------- -------------------------------------------------------------------------------------- I hereby certify that a'ye pr ed this application and tbo4he work will be done in accordance with San Joaquin County ordinances, State laws, and r pr the S aquin Local Health District. f ------------------------ --- ---- ��w E ------------- Chown Contractor) �e s, (Signed). --- ��__ _r By:__................- ------- iv ----------------- (Plot plan, showing size of on of system in, relation t ails, buildings, etc., can placed on reverse side). FOR DEPARTMENT USE ONLY REVIEWED BY------------------------ APPLICATION ACCEPTED BY----- --------------------------------------- ---------------------------------- DATE-------- '`--- --------------------------- --------------------------------------- DATE------------------------- BUILDINGPERMIT ISSUED,_)..-._.'.--------------------------------------------I-----------------•-----•-------•--------------- DATE----------------------------------- -•--• - Alterations ATE------------------------------------------------------------- Alterations and/or recommendations:--------------- -- -----------------------------------------------------------------------........................------------------------------------------- -------------------------6 ------------------------------------------------------------------------------- ----_--------------------------------------------------------- 11 - ---------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- ------------------------------------ -- ----- ---------------------------------------------------------------------------I----------------------------------------------------------------------------------------------- ------------------------------------- ------------ ----------- ------- ------------------------------- -------------------------------- ----------------------------------------------------------------- -------- FINAL INSPECTION BY:--" = = --}'�------------------------ - Date--------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 9 Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100