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APPLICATION FOR SANITATION PERMIT Permit No. <br /> lj (Complete in Duplicate) 7 S� <br /> Date Issued --- <br /> - _____~_______ <br /> Application 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 Ordinance No. q49. s <br /> JOB ADDRESS AND LOCATION... ! -_fi1/- 1x1 � -- -------------------------------------------------- --------- <br /> Owner's Name---------........•---_------------------:97� -�- l/-ko-S------------ ---------------------------------- Phone------N---0--;1-g!---------- <br /> Address-----•---------•--------•-----------------------------��`` �� - ----------- - ---------------------------------------------------------------------- <br /> ------------ / <br /> Contractor's Name----------------------------- -1----- ­41j;;rn------------ Phone------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑' Motel ❑ Other ❑ <br /> i <br /> Number of living units: .--___ Number of bedrooms __yNumber of baths I___ Lot size ----0,a-_ X---- ________________ <br /> Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3,deet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobej< Hardpan ❑ <br />}' Previous Application Made: Yes No ❑ New Construction: Yes ❑ No ❑ fj,.�.. ` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> p-ft T fi Distance from nearest well_________'______Distance from foundation-------------------Materiai-------------------------------_________________- <br /> No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity---------------------- (\� <br /> Disposal Field: Distance from near st wellIff lite----Distance from foundation__/_Q_�______Distance to nearest lot <br /> Number of lines-----i------- f_ __�f__________Length of each line____�Q_-'__-__-_-Width of trench__- �__°_________________ <br /> Type of filter material__�_XZ,-__efL----Depth of filter material---IAT ------------Total length___�___Q '--—_______________ <br /> aagggee Pit: Distance to.nearest well----------------------Distance from foundation-------------------Distance to nearest lot line----------------- <br /> Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----_--__----------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> El <br /> _________________ ______________❑ Size: Diameter--------------------------------------Depth----- -----------------------------------------------Liquid Capacity-----------------------------gals. <br /> Privy: Distance from nearest we]-------------------------------------------------Distance from nearest building__________-__----_-__----__--------_----_. <br /> ❑ Distance to nearest lot line --------------------------- ----------------------------------------------------------------------------------------------- i <br /> Remodeling an or rep -'rJ- <br /> ' 1 --- --- ---- ---... _n (descr ------ <br /> pirt- ---------------------- - --------¢-I.-w` ---• -- ---------------------------------------- --------•-----------•----------------------------- <br /> ------------------------------------------------------------------------------- --------------------------- _9_4--- ---------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that 1 have a red this applica+io and that the work will be done in accordance with San Joaquin County <br /> ordinances, SSS_ ws, a rules and egulations of the an Joaqui, Local Health District. <br /> i <br /> (Signed) r �'...... - - = �=--� r Contractor) E <br /> ----- <br /> -- <br /> 8. : -- -------------)Title) �r�'+11 _/21--------------- <br /> (Plot plan, inng s' a of cd, location of system n relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPA TMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------------------- c 'y ---------------------------------------- DATE---------F <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------- ------ DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------- ------------------------------------------ ------ DATE <br /> Alterations and/or recommendations:---------------- ------------------------------------------------------------------------------------------------------------- <br /> -------------------------------•----------------------------•---------------------------------------------------------------------------------------------------------------------------•-------------------•----------•------ <br /> ------- -------- ---------------------------------------------------------------------------------------I------------------------------------------------------------- <br /> • -------- <br /> ------------ <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 8-51 Revised W-2100 <br />