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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Application is hereby made to the San Joaquin Local Health District fo r a pe mit to_,construct and install the work herein described. <br /> This application is made in compliance with County Or&nance No. 54.9 <br /> ----------------------------------- ------------------- <br /> JOB ADDRESS AND LO?_P�ION----------------7e;:�------- - --- --- ------ ---- <br /> ; Phon <br /> Owner's Name----------------- U-t-----L-.1------------ - ------ ------------------- ---- ------------------------- ------------- <br /> ---------------------------------- ------------- <br /> se A -------- —--- ---- <br /> Address--- ------------------------ .........7,,.4 �" ------- ------—, Phone--7–��­?-7 <br /> Contractor's Name------------- - ------- /------ ------------------------------------------------------------ <br /> Installation will serve: Re\;�dence)d Apartment House 0 Commercial [] Trailer Court 0 Motel [1 0*ther 0 <br /> ­,6�p-e--Y-�....Lsr------------------------ <br /> Number of living units: I------ Number of bedrooms A,�Number of baths Lot size -Sp f t. <br /> Wafer Supply: Public system El Community system [I Private Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand D Gravel E] Sandy Loam Ej Clay Loam 0 Clay [] Adobe LIV Hardpan 0 <br /> N <br /> Previous Application Made: Yes 0 No F-l New Construction: Yes [j -No.F] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 00 feet.) <br /> (No septic tank or cesspool permitted if public sewer is available within 2 <br /> Septic Tank: Distance from nearest-well_----. -------Distance from foundation--------------------Material------------------------------------ <br /> --------- --- <br /> ❑ Liquid depth---------------- --------Capacity------------------- <br /> No. of compartments—----------- - ----------Size------------------------------- I --- <br /> Field: Distance from nearest well..._--.--Distance Distance from foundation----3-0------ Distance to nearest lot line----- _.---- <br /> Disposal --- <br /> ------------------ <br /> .1 7i <br /> Number o' lines------ ----------Length of each line-- 2��-- ----------Width of trench.- <br /> ----------Total length------ ­­--------------------- <br /> 'Type of filter maferiallv'-'R-."----------Depth of filter maferia -9 <br /> Seepage Pit: Distance to nearest well." Distance Grrfoundation___.....__.._. <br /> -....Distance to nearest lot line----------- <br /> ❑ <br /> ine-----------F1 Number of pits----------------------Lining material----------- ----------.Size: Diameter------------------ ----Depth---------- ---------------------- <br /> Cesspool: Distance from nearest well.:...............Distance from foundation-..--------_------ Lining material_---..--..__..----------------------- <br /> F1Si7e: Diameter--------:----------------------------Dep'th-------------------------I----------------------------Liquid Capacity—----­----- -------------g als. <br /> Privy: Distance from nearest well..............._.-.--"--------------------------Distance- - frio' m neares; building----------------------------------------- <br /> Distance to nearest lot line-------------------------------------------------------------------------------- ------------------------------------------------ <br /> ❑ <br /> --- ------------------------ ---------------------------- <br /> ---- -------------------- --- <br /> Remodeling and/or repairing (describe}---------- -- ---- - -------------------------- ---------- ---- ---- ---------- ------------------------------------ -------- ------- <br /> ------------------------------- <br /> ------I—-------------------------------------------------- <br /> — ------- --------- -- ------ <br /> /------------------------------ --------- ----------- <br /> ------------------------------------- --------- <br /> ----------------------- <br /> ---------- ---------------------------- -------------- - -------- ----------------f <br /> I hereby cer!if� have )r red this application and that the work will be done in accordance %Wh San Joaquin County <br /> ordinances. S,qeaws, a rules and of the San Joaquin Local Health District. <br /> �, 0 (Ownertan r Conlr efor) <br /> ------------ <br /> (Signed)--------- al ---------V - ----- ---- -- --- -- <br /> .. . ..... . .. .... <br /> -------- --(Title}------- <br /> (Plot <br /> -(Tit e -------- <br /> By:--­------------­ ------- -------- e place on reverse side <br /> --- ------------ ------- -- <br /> (Plot plan, showing size-ze..of lot, location of system n relation to wells buildings, etc., can b <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- ----------------- -------------- - --------------------------- DATE---------------_f-'. J-1--sc.3--------- -- <br /> REVIEWEDBY------------------------------------------------ ---------------------------- #- I--- ------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------- -----------I-------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:_.-.._----------- ----------- --------------- --------------------------------------------------------------------------------------------------------------- <br /> -- -------------------------------------------------------------------I------------------------------------------------------------I----------------------------------------------------------- <br /> - - ----------I------------------------ - --------------------------------------------------------I------------------------------------------------------------------------------------- <br /> ---- ------------------------------------------------------------ ---------- -------------------------- ---------- -----------­----------------------------------------- ------ --------------- <br /> ------------------- ---------- ----------------- <br /> --------------------- <br /> y <br /> ---------- <br /> --------------- <br /> - --------------------------------------------------------------------------- --------------------- <br /> -------- <br /> -------------1------------------------ ------------------ ----------- -------------------------- <br /> FINALINSPECTION BY:---------------------------1� Date------------------------- ------------ --------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Stre®t 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />