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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicatel <br /> Data Issued __��/�---_-_ <br /> gA <br /> plica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> 's application is made in compliance with County Ordinance No. 549. <br /> 1-77 02-0- o_9 <br /> -7 00 97' '- . t <br /> - -----------V(__ <br /> JOB ADDRESS AND �9CATICN___ ----------------- <br /> Owner's Name---------- <br /> 4U_r_11C_ - -- <br /> Address-------------­- " I . ---- ------------------------------------------------------------- Phone------------------------------------ <br /> ------ --------------------------- <br /> -- ---------------------------------------------------------------------------------------------------------------- <br /> Nme---ZD---- ------ ---;�� ---------------------------------- <br /> Contractor's a- 1� _L , PC- .c - e- eAlLe, Phonw_Ara----a/- <br /> Installation <br /> will serve. Residence goAp'arfmenf House E] Commercial 5L Trailer Court F <br /> _] Motel Ll Other E] <br /> Number of living units: $... Number of bedrooms -------- Number of baths Lot size ---- <br /> Water Supply: Public system El Community s- ------------ <br /> yste M_ E] Private 3--15epth to Water Table 10 ft. <br /> Character of soil to a depth of 3 feet: ' Sand ❑ Gravel E]- Sandy Loam E] Clay Loam El Clay0 Adobe 23--HardFian- <br /> Previous Applicaf ion Made: Yes F] No.,O- New Construction: Yes L!g_-N 0 [] 7 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: . <br /> (No septic tank or cesspool permitted j <br /> if public sewer is available within 200 feet-.) iL <br /> -- <br /> Septic Tank: Distance from nearest we11_404_1-----Distancefrom-founclati6ti'.4"20-- ----------Material---- <br /> No, of corripartmerifs------- ------------Size-,_ 'U�6id -depth- ---Capacity-------- <br /> Disposal Field: Distance from nearest well...At6-:1DIstance from foundation------ W_ r!__.Distance to nearest lot line 0,01- <br /> Number of lines____.____ Jr-__________Length of each <br /> t-847,dth of trench_____-`-_- � � <br /> Type <br /> rench------ <br /> Type of filter material-- -----�!J?'__Depfh of filter material-- -------------Total length.----.,._:P_*0 <br /> '2 '7- 0 <br /> Se,epage Pit:' '- Disfan"cL-e to nearest well----------------------Distance from foundation---------------------Distance to nearesf lot line--_____________ <br /> Number of pits------------------ ---Lining material-----------------------Size: Diameter------------------' ---- --:�Depih_ <br /> --------------n;-14- <br /> Cesspool: Distance fi-orn nearest well_________________ -Distance from foundation--------------------Lining material----------------�­ - ---------- <br /> El Size, Diameter .1------ <br /> -Depth----_------------------------ ---------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building__ ___ -------------:--- <br /> ------ <br /> - <br /> -------------------------:-------------------- -------------------- A, <br /> ---------------------m <br /> Remodeling and/or repairing (describe)-------------C 11, ----------- ------------- --- ----- -- - - ------------------------- <br /> ----------­----------_----------------------------------------------------- ------------------------------------- <br /> -----------------------------------6-------------- <br /> ..:__ <br /> -------------- ---------------I—------------------------------------ ----------------- ----------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------I------------------------------------------------------ ------------- ------------------- ----------------------------------- <br /> ----------------------------------- ------- <br /> I hereby certify that I have prepared this application and that the work Will be donei.15 <br /> ordinances; State laws," and rules and regulations of the San Joaquin Local Health District i.raccorddnc� "with San Joaquin County <br /> (Signed)------- -------- -------- ------ ------------------ -----------(O.Wner and/or Contrador) <br /> By:-- <br /> (Plo+ plan, showing <br /> FOR DEPARTMENT USE ONLY" ff <br /> APPLICATION ACCEPTED BY-Z. 'Ir—/ I <br /> <- ------------------ -- ----- ------------------- A DA'TE-5::- <br /> REVIEWEDBY--------------- i=&----------- ------- --------------------------------- <br /> ......... ------------------------------- DATE_ <br /> BUILDING PERMIT ISSUED---------------------------- ------------------------------ DATE.------ --------------------------------------------------- <br /> Alterations and/or recommendations:-- -_- - - <br /> -------------------------------------•-- <br /> ;2-:4--- -------------------4---------------------- ------------------------- <br /> - ---- ----- ------ <br /> ------------------------ -------------------------------- ------------ ------------ <br /> -------------------------------------------------------------- .)----- -5�_� - - ------------------- <br /> ----------------------------------------------- --------------------- o4 <br /> ------------------------- <br /> --------------------------- <br /> ...... ------------- -- --------------- <br /> ------ <br /> FINAL 'INSPECTION BY:--A 2 <br /> -- - ---- -----I-------- -------- --1 <br /> Date---------- -- --- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sti-eef 132 Sycamore Sfreet 814 North "C" Street <br /> Stockton, California Lodi, Cal;fornle Manteca, California Tracy, California <br /> ES-9-2M Revised W-2100 <br />