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41) APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 5- Date Issued ____ ------------- Applica4-ion is hereby made to the San Joapuin Local Health District for a permit to construct and install the work herein described. This application is made in compliance ounfy Ordinance N3?- 549 -------- --- ----- ------------ ---- - ------------------------------------------ JOB ADDRESS AND LOCATION..i - --- ------- --- -------------------- Owner's Name------- ----------- Phone AcIdress..__2_7J.A___0_t.. -1 -- - ----- ----------------------------- - ------------- ---------------------------- -------------------------------------------------------------- Contractor'sPhone6/4 Installation will serve: Residence AF—Apartment House E] Commercial E] Trailer Court E] Motel Ej Other [] .Number of living units: .--f--- Number of bedrooms ._T_ Number of baths JJ!r'm Lot size ---_I- o-------- ---------- Wafer Supply: Public system Ej Community system E] Private 2�}--13epth to Water Table �_P ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam' 0 Clay E3 Adobe 6—Vardpan ❑ Previous Application Made: Yes 0 No t_ d Iew Construction: Yes 41—Ne,0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available 'within 200 feet.) Septic Tank: Distance from nearest well--,- O--_-__:Distance' from'foLYndation-'--,/O--------k4afe -U<�' No. of compartments----___2—------------ - 'lial-----ell---------- "---------- Size ------Liquid depjh____, _'_t-.--------Capacity ---4------------ Disposal Field: Distance from nearest w047-a-Z...Distance from foundation----/'P__`._'*_,Di-5fance to nearest lot line line--/C1____-•• E4-- Number of lines------_-_-!_-_--_'-:: -777.�._L6ngfh f each line____;;1_1S—---------- ----Width of french---- - - --- o a -----_----- Type of filter ------Depth of filter material------f9__'____Tota1 length------7S:7--------------------------- Seep?ge Pit: Distance to nearest well...//47__ Distance rr�fou 'e f6'hearest lot line-_/0 ---------Disfa�� - - --------------- Number of p�fs---I---- ---Lining material-- ___- :Size: Diamefer__34--------- ---Depth- --Depfk----..9— -------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------__.-------_- Lining material------_----__--------- -- ❑ aterial--------------------------El Size: Diameter_-(-----------------------------------Death-------------------------:-------------I------------ Liquid Capacity----------------------------gals.- I . Privy; Distance from nearcsf well----_----- ---- --------------------------------Distance from nearest building------------------------- q ----------------- ❑ Distance to nearest lot line-.------------------------------ -- Remodeling and/or repairing (describe):---__-------------- -------------------.--r----------------------- ------------------_-------------------- ---------------------q------------------------------------------------�i. -------------I------------------------------------------------------- -----------------------------------------------------------------------------------------------------------•----------------------•------------•------------------ --------------------------------------- --------------------------------------------------------------------------------------------------------------- -------------------------- --------------------------------•-----------•--------------•- ---------------------------------- ---- - - -- --- --- ----------- - ---- -- --- ------ ---- ------- -- - - ---- I hereby certify that I have prepared this application and that the work-will'-b-e--d-o-n-e--jn-accord-a-n-ce--w,ifh"San,-J,oa-quin--C-o-u-nty: ordinances, State laws and rul and regulations of t San Joaquin Local Health District. {Signed}------------ -- ----- -------------------- --- --------------- ---- ----- -------------------------------------------------------------------------(OWITer-mycl/op-Contractor) By:----- ------ --------- ------------------------------------------ ----- ----------- -------------------- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------ ------- --- ---------- --- ------------------------------------------- DATE---- REVIEWED REVIEWED BY 7;;�E -------- EN ----------------------------------- ----------- -- - --- - -----------------------------I-------------------I----------- DATE_--------- ----------k BUILDING PERMIT ISSUED--------------------------------- ----------------------------------------------------------- DATE----------------- ----------- Alterations and/or recommendations:------------------------ W_ ----------------------------------------------------------------------------------------- ----------------------------------------------I------------- - -------I---------------------------------------- ...------------ --------------------------------- ------------------------- ------------------- ----------------------- --------------------------------------------------I---------------------------------------------------------------- 1-------------------------I--------------------------------------------------------------------------- ----------------- ------------------ --- ------------7-------------------------------------- ----------------- ----- ------------------------------ ---------- ----------------------------------------------------------------------- ---------------- ----- ---------------------------------------------------------------------- FINAL INSPECTION BY:---- -------- 5------------------------------- Date---- ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWDUD 12-54