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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Applicatidn 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. r49. <br /> ------ <br /> JOB ADDRESS AND LOCATION___-_-9_7,2--Z------------ <br /> ------------- <br /> ----------------------- <br /> Phone------ ------------ <br /> Owner's Name------------ <br /> . ,�,�'-h�`1��---- '�`�'----- ------------------------- <br /> Address <br /> ame------------Address----__----------------------- -------------------------------------------- <br /> ,4 -------------------------------------------------------- Phone-- <br /> Contractor's Name----------------- --- <br /> Installation will serve: Residence N Apartment House F Commercial [I Trailer Court E] Motel ❑ Other El <br /> I -Ar " 1-------------I----------- <br /> Number of living units: Number of bedrooms __2__ Number of baths __/--- Lot size ----- <br /> Water Supply: Public system Community system 'El Private El Depth to Water Table'rs- ft. <br /> Character of soil to a depth of 3 feet: Sand El Gravel El Sandy Loam El Clay Loam El Clay E] Adobe Z Hardpan <br /> ❑ <br /> Previous Application Made: Yes 0 No X New Construction: Yes Ej No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 3 <br /> ----------------- <br /> ------------- <br /> Septic Tank: Distance from nearesi welj___�--------Distance from foundation-_--___ --_--____.Material------4------------------------ <br /> --- ------C'pacity"?A0 a <br /> No. of compartments--------go!j....._--Size----. -Liquid depth-------- -- -i <br /> R] ---- <br /> Disposal Field: Distance from nearest well-_73#W,_,*__.Distance from foundafion____;A­j-------Distance <br /> Distance to nearest lot line.__ Q__/ <br /> -----------Length of each line-----------Z—f-------------Width of french---��_*-11,------ ----------- <br /> Number of lines--------- '/ -5 / <br /> er a�------ -----.-- -Total length_-___-_--_-t9------------ <br /> Type of filter material------- Depth of filter mat 1 Seepage Pit: Distance to nearest -Distance from founclafion__Itir__�--------Distance 0 to nearest lot line___.____.- ------------------ <br /> Number of pits_--___.O'h4&e,e---Lining material__-A_14,?-k-------Size: Diameter---------1_V__1f---------Depth___-X--5'-" <br /> Cesspool: Distance from nearest well---------------- Distance from foundation--------------------Lining material_---____-___-______________________ <br /> Size: Diameter--------------------------------------Depth---------------------------------- ------------ ----Liquid Capacity----------------------------gals.' <br /> ❑ <br /> ----------------- <br /> Privy- Distance from nearest well-_--------------------------------------------- Distance from nearest building------------------------------------------ <br /> F-1 Distance to nearest lot line---------------------------------------------------------------------------------------------- ------------------ <br /> I <br /> A".e __,0� � 7 <br /> 1,g oi�, I- - -----------*-------------- <br /> Remodeling and/or repairing (describe):---------ef" -- ------ - -_ <br /> -------------------------------------------------------------------------------------- ---------------------------I------------------------------(/- -- ------------------------------_-----_------------------ <br /> ------------- <br /> -----------------------­_­-----------------I-------------------------------------------------------------------------­----------------------------------------------------- <br /> ----------------------------------------------------------------------­------.............I------------------------------------------------------------------------- -I--------------------------I----------- <br /> hereby certify that I have prepared this aF -------------- <br /> oplication and that the work will be done in accordance with San Joaquin County <br /> I <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)_ <br /> ----------- -------'Alff--------------------------------------------------------(Owner'and/or Contractor) <br /> ----------------------------------------------)Title)-------to -------------------------------- <br /> By:-----------------2-.), - .. 5 <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE_----- A?-----j ----------- <br /> APPLICATION ACCEPTED BY----------------- f---- AV �,/ I- <br /> Vjr ---------------------------- DATE_:---t.91----I---------7--------------------------- <br /> REVIEWEDBY--------------------------------------- - ---- ---------------------------------------- ------------------- DATE---------- <br /> I-------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------ ---- --------------------------- <br /> Alterations and/or recommendations---- ---------- ------------------------------------------------------------------------- <br /> ------------------------- <br /> ---------------------------------------------------------- -- ------- -------------------------------------------- ------- —------------------------------------------ <br /> Date7-------------------------------------- <br /> ----- ----- -- -- ------- <br /> FINAL 'INSPECTION BY SAN-JO-AQ-U-I-N_LOCAL- - HEALTH DISTRICT IX <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> TracCaliforniaStockton, California Lodi, California Manteca, California y, <br /> E5-9-2M B-51 Revised W-2100 <br />