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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) Date Issued <br /> 711 <br /> kiipplica4-ion is hereby made to'the San Joaquin Local Health District for a perm-iifo and install the l.;olk herein described. <br /> . <br /> This application is made incompliance with County Ordinance No. 549. <br /> 411 -7 n- CA) . C-6V4,,,0_W-4- -1r <br /> JOB ADDRESS AND LOCATJON V. a-�--------�_ C-------------•-- <br /> .. ............ _41 <br /> Owner's Name..----- . ....... ............................................. ­­..................... Phone..........._....__._....... ..... <br /> Address-------------- .10-A...... ....... .1 •- ---------- ..............I.... .................................... .............................................................. <br /> Contractor's Name-.......... ............................................. ...­­................................................. Phone..................... <br /> Installation will serve:I ResidencelAparfrnent House 0 Commercial E] Trailer Court [:] Motel 0 Other E] <br /> Number of living units-11 Number of bedrooms..... .-. Number of baths ........ Lot size ----- U <br /> ­ <br /> —.........�f.......... <br /> .......... ---------- <br /> Water Sup`pIy:—P6bIic system <br /> ,[0 Community system E] Private N' Depth to Water Tab], <br /> Character of sail to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam[] Clay[3 Adobe Hardpan ❑ <br /> Previous Application Made: Yies E] No New Construction- Yes E] No <br /> i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank-or cesspool-permit#ed'if public seweris-`a ailable within200eet.) ~y <br /> Septic Tb Distance from nearest well.................Distance from foundation-...,-...............Material................................................. <br /> Septic <br /> No. of compartments . ...... Size...............................Liquid depth----------------------. Capacity-----------•--------.- <br /> 1� <br /> Disposal F i e Id Distance from nearest welt.._.... .� <br /> � ­ D i sta nce from fc,U*ndation_i ......Distance to nearest lot line_ .__.___ <br /> Number.of lines.........../............... ...Length of each Ine........:3ap........Width of trench...14.4.................. <br /> Type of filter maferial.4t -.Depth of filter material....... Total length------tl_0-0...............J....r. <br /> Distance to nearest .......................Distance frorp f9un <br /> ,Apf i5T....................Distonce to nearest lot line....,°._..____ <br /> Number of pits............... Size;: Diameter......... Depth---------------------t---------- <br /> '1 10 4 <br /> Cesspool: Distance from nearest well.................Distance from q0undation- - __-___.-..__.Lining material................. ................ <br /> 1� <br /> Size: Diameter_------------_------------- - _Depth.......................................... ........Liquid Capacity............................gals, <br /> ......... <br /> Privy: Distance from nearest-w_e'll............. ............................... -Distance from nearest bu;l'ing------------------------------------------ <br /> ElDistance to nearest lot line...... . ................................ --------------------- ................................................................ <br /> Remodelinqand/or repairingl (describe):.......................... ---------------------------------.....................................;---------------------------------------­--—........ <br /> Ile .........................•R--•---.-----------:_--------- <br /> .....------------------------- ............................. <br /> -----­--------------- -------------------------------­--............---------------------------�­­,: <br /> .............................................................. ........................ .............................. ...................................-------------------------............... ............ <br /> ............ <br /> ........................ ....................................................... .......................................... <br /> .......... -- <br /> I hereby.certify that I have prepared this ap,lication.�ind that the work will be done in accordance with San Joaqui.-- U­.'y�^ <br /> V 4, ,, 't . <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _�r A r. "t <br /> (Signed .................................... ------------------------------ ----(Owner and/or Contractor) <br /> ............ .... <br /> .. ... V_w <br /> B -------------------------------- <br /> (Plot plan, showing size of IoF, location of system in relation to wells, buildings, etc., can be placed an reverse side). <br /> 9 <br /> 11 FOR DEPARTMENT USE ONLY <br /> BY----------------------------------- <br /> APPLICATION ACCEPTED ---------------------------- ... ............................ DATE..--•--........._.. �------------------------- <br /> II 57.(_ ........................... DATE... .............................. <br /> REVIEWED BY...-IT <br /> BUILDINGPERMIT ISSUED .11 .............................. ...................... DATE......._............................................... .. <br /> Alterations and/or recommendations:.......:.............. ...................... ...........................................................-­--------------------_ <br /> ........................... ........ .---............._..........-------•-•--••----------•. ----•••-----------•-----............... ................................................. <br /> II <br /> ..........................._------------------------- ...............................I.................................-----_------------ .................................................. <br /> .......... ............................. . .... ........................... ..... .........................................................................................................................I......... <br /> .................I——-------------------­- --- ---------- ...................... .......... ...........— ................................................. <br /> FINAL INSPECTION BY:...I;. ... ......... ................------- Date. ...Tiw.............f....... - ----------------------------------------- <br /> . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 122 Sycamore Street 814 North "C" StraO <br /> Stockton, California Lodi,-California Manteca. California Tracy, California <br /> IK <br /> E_9-9­2m 145446 AYWCnD 13-5. <br />