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APPLICATION FOR SANITATION PERMIT Permit No.3--fe!Z ------ <br /> (Complete in Duplicate) Date Issued <br /> I-V <br /> Application is hereby made to the San Joaquin Local Health Di ict for a permit to construct and install the work herein described. <br /> This application is made in compliance with County OrdinancOlol, 549. <br /> ------------------------------------------------------------- <br /> N-------- --- ---- -------- <br /> JOB ADDRESS AND L A Phone.77��;� <br /> owner's Name------- ---------------------- - ------- -------------- <br /> 14e ---------------------------------------------- <br /> Address ----- Phone <br /> Contractor's Name <br /> ---- ------- --- - -A-i House [I Commercial ❑ Trailer Court El Motel 0 Other E3 <br /> installation will serve: Residence Apartment, ----------------------- <br /> t baths J,_ Lot size ------ <br /> Number of beclroomsQ-�___ Number of - <br /> Number of living units: to W'ater Table-_I�ft- <br /> Community system Private El -Depth <br /> - Public T7te-m pan ❑ (13 <br /> Water.Supply: Sandy Loam El Clay'Loarn 0 Clay Adob 9. Hard <br /> depth of 3 feet: Sand ❑ Gravel Charact;r of soil to a <br /> Previous Application Made: Yes ❑FN6�'��" Ne' 'C ristruction: Yes <br /> TYPE OF INSTALLATION AND Sl ION'S'. 0 <br /> public sewer is available within 200 feet.) <br /> 0 ------------------- <br /> from foundation___-_____---------- <br /> Material--------------=--- <br /> Capacity----------------------- <br /> IN septic tank or cesspool permitted if pu ------------ <br /> Septic Tank: Distance from nearest well________________Distance <br /> No. of compartments------- ------------Size-------------------------------Liquid depth----------------- -------- <br /> Mstance from foundation ------------Distance to nearest lot lin <br /> Disposal Field- Distance from nearest wel <br /> --7_��ro Width of trench__________ ------------ <br /> -of each line-----­<:,�- --------- Ix <br /> ------ ---- -----Length' 1 .51 <br /> Number o' lines------------ pfb of filter mafer�al---- _--Total length- <br /> Type of filter material - -- ---------De nearest lot line- <br /> ---------------- <br /> nearest well______________________Distance----------Distance from foundation---- ---------------Distance to n <br /> 'Seepage Pit: Distance to ne -----------------------Size: Diameter-----------------------Depth---------------------------------- <br /> El Number of pits-- -------------Lining material Lining material ------- <br /> -------- -- ----- --- ...i�� <br /> ��� u UOdi j Capacity--'t gals <br /> from foundation <br /> Cesspool: Distance from nearest wellgal <br /> iqui <br /> DepthIt <br /> Size-: Diameter----- --------- - ------ ------------ ? <br /> El from nearest building----.- ---------------------------------- <br /> a• Privy: Distance fronI. nearest well------------------------- Distance ------------------- <br /> Distance to nearest lot Iine------------------------- --?/1--------------------------------------- <br /> ❑ <br /> 1 1.11.1 i __;------------------------------------------------- <br /> 4�_ ---------------------- <br /> Remodeling and/or repairing (clescribe):_-- <br /> 5-- --------I----------------------------------------------------------------*------------------------------- <br /> -------------------------------------------------------------------------------------------------------� I -------------------------- <br /> Z. ------------------------- - <br /> ---------------------------------------- <br /> ------------------------------------------------------------- <br /> ------------------------- ------------------------- ---------------------- -- ------------------------------------------------------------ <br /> ------------------------------------------------- <br /> ------------------------ --------------------------------*----------------------- <br /> I hereby certify that I have prepared thisor applicahe San Joaqution and that the work Heawill lth be donicte in accordance with San Joaquin County <br /> I * is of the Local Distr . <br /> ordinances. State law ind rul a ;reguati <br /> (Owner and/or Contractor) <br /> _ ---------- <br /> --------------------------------------------------------- --- ---------- <br /> _-4m tose-------- <br /> - ----- Ilse sid6f <br /> (Signed)---------------- ----- - - ---------------- <br /> By:---------- -- can b <br /> (plot plan.'showing size-Ze lot, location of system in relation to wells. buildings, etc., e(pl ted n reverse /V <br /> FOR DEPARTMENT USE ONLY <br /> ------------------------------------------------- <br /> REVIEWED <br /> -- 'DATE_ --------- <br /> APPLICATION ACCEPTED BY-- ----- ------------------- I ----- <br /> ----------------------------------------------- <br /> REVIEWED BY-------------------------------- ------- ------------------------------ ---- DA <br /> TE <br /> E -------------------- <br /> - <br /> D TE__D&TE-- <br /> BUILDING PERMIT ISSUED--------------------------------- ------------ <br /> --- .......... <br /> ... ---- ----- <br /> Alterations and/or recommendations. <br /> ---------- ------------1�_ <br /> --------Z�eC2---- ------ <br /> •'' ------ <br /> -------------------- <br /> ---------- -A <br /> ------------------ -- ----- - ------ <br /> A --------------- <br /> -------------d- <br /> A <br /> Z �4 <br /> Date_ -- -- ----------------------------------------- <br /> FINAL INSPECTION BY:----------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> t30 South American Street Manteca, California Tracy, California <br /> Stockton, California Lodi, California <br /> ES-9-2M 10-52 Revised W-2100 <br />