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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Applica+ion is hereby 'made 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 with County OrdiDAQce No. 509 <br /> JOB ADDRESS A LOCATION_____-- ---Z- ----- - -------t <br /> ...Lp ----41 ------------------------ <br /> -- - -- -------- <br /> _I K r------------------ <br /> Owner's Name--- ------- ---- - --- --- ------------------------- <br /> --------------------- <br /> Address--------------------- <br /> Contractor's <br /> ddress--------------------- ---------------- <br /> Ir 7-1----------- <br /> P 0A 17 50 'S, 7rA <br /> Contractor's Name-------------------------------- d./ I --------Z------ . - A <br /> Installation will serve: Residence [P-`�Apartment House ❑ Commercial El Trailer Court ❑ Motel [j Other El <br /> Number of living units: Number of bedrooms _P�" Number of baths ---/-- Lot size /-------------------------------- <br /> I <br /> Water Supply: Public system 2--c-ommunify system []. Private [] Depth to Water Table 114� <br /> - ft. <br /> Character of soil to a.depth of 3 feet: Sand Ej Gravel E] Sandy Loam 0 Clay Loam E] Clay E] Adobe 0"H'ardpan El <br /> Previous Application Made: Yes E] No P- '• ew Construction. Yes Ej No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available within 200 fee+.) <br /> is T Distance from nearest-well---:-----------�Disfance from foundation---------------------Material---------------------------I <br /> No. of compartments--------------------------Size---------------I—,----------Liquid clepth--------------------------Capacity----------------------- <br /> osal,F*eld: Distance from nearest well-------------- from foundation------------------- Distance to nearest lot line___.___..._.____. <br /> Number-of lines.'------------------------ -----------Length of each line-------------------------s-----Width of trench----------------------------------- <br /> Type of filter material __ %uDepth of filter material=:__.__________ ______Total length_______-__- _'_________.___________--___. <br /> Seepage Distance to neall!esttl __.______:Distance fr m f u-clation....&O.--�_.Disitance to nearest ,ot line___ <br /> P-P* <br /> Number of pits-17 t ------------Lining material- Size: Diameter-- --------- <br /> rL fion--------------------Lining material__-_----___.__._____.______________.I <br /> Cesspool: D ista Distance ro m.nea sf'well-----------------Distance from founda <br /> 0 Size. Diameter--I--- -­1.1--------Depth--------------------------------- ------------- Capacity------'---------------- .gals. <br /> ' nearest-well--------=------------------------------------I _1T . I. Q� , <br /> Privy: Distance from ----Distance from nearest'building-c-------I--------------------- -- <br /> 'Ii�' " ------------------- ------------------------ -------- <br /> ❑ Distance'to-nearest lot e--------------------------- <br /> ------------------ <br /> Remodeling and/or repairing (describ.}:_tO?��....n_1*__Ar,_ ___....-_-•_.._________A-- - ---------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------I--------------------------------------- ----------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ------------------- <br /> ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- <br /> I [ _4 Plic <br /> I <br /> that eve prepared t6;f\ap ;-f and that +he work will be 'done in accordance with San Joaquin County <br /> certify --i - ---------------------�' an <br /> ------ ---- <br /> ------------hereby _e <br /> f�r�i - - -' <br /> 'a i� aPPI"c <br /> �c w u esl\an reguN�its of th San Joaquin Local Health District. <br /> ordinances, St,f ws, and I <br /> (Signed)----------- ------------ P-­ -------------------------- -- ------ Contractor) <br /> By:----------------- -- --------- <br /> ................................................. --------- ------ ------(Title)----- ---------------------- ----- <br /> build <br /> (Plot plan, showing size of lot, location of system rela n i-o"wells, i in etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-.--- <br /> ------------------------- - - ---------- ------- DATE-------------- G1 <br /> )_��------------------------------ -------- ---------------- <br /> REVIEWEDBY---------------------------------------------------------------------------------- ------------------------------------------ DATE <br /> BUILDINGPERMIT ISSUED----- --------••-------•--­-------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> t 0.t <br /> Alterafl 's and/or recommendations:-----------------0------ ...............r-------------------------------0 <br /> ­------------­ <br /> ------------- <br /> -------------- <br /> .......... --- -----a--------- -t ...... .......� ------------- <br /> ----- ------------------------------------------- P46 A-0---( __1---------- -------:------------------ <br /> je, 1, ------------------------------ -----------I--------------------- <br /> 10 A I-- t U <br /> ----------- jL_____kN <br /> 0-- x-- --------------------------------------------------------------- <br /> -------------------------------­----------- <br /> ---- ---- - ----------- <br /> FINAL INSPECTION BY:----- ----------------------------------- 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 /> ES-9-2M Revised.W-2= <br />