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V APPLICATION FOR SANITATION PERMIT Permit No.
<br />(Complete in Duplicate) Date Issued f?.S
<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. 549.,_�p c j
<br />-7 "K D LU) •
<br />JOB ADDRESS AND LOCATION_...... I % �� 7 ? ' ?'?sia2� +xcrr.. : `..�t'L..-.- ....�................. .
<br />,<.�. ........................ Phone_+w+.
<br />Owner's Namo..............................._. ;:�a _._..... .........,...,....... ,
<br />Address,__ ...... __ .............. ........ _... _....._
<br />Contractor's Name.........................
<br />6P.'_.
<br />...........
<br />Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [�' Other 2re
<br />Number of living units:....,.._ Number of bedrooms ........ Number of baths ... C. Lct size .......,�...1�-�_._::�......... ,.»...
<br />Water Supply. Public system ❑ Community system L7 Private R, Depth to Water Table ........ ft.
<br />Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑
<br />Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑
<br />TYPE OF INSTALLATION AND SPECIFICATIONS:
<br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.)
<br />Distance from nearest well_ ...... . __,..Distance from foundation... ------ ........................... {
<br />No. of compartments.........., __. __Sizrs................................Li uid depth_____ ._,. Ca a6 a
<br />Distance from nearest well.e`ov�...�_.... Distance from foundation..._/.�-_-Distance to nearest lo� line .... .1.0.......
<br />Number o'i lines...__..._.#I...,-.. Length of each line.... J. Q.a.''...._._...Width of trench....--.. -�•� t� '
<br />r + `.....
<br />Type of filter material........._ ...f�:l.� Depth of filter material._.._....�.g. �.�_.Total length_ ...... 1__Q. �..'......,.,.,.....
<br />Distance to nearest we,i ......................Distance from foundation... ... .._._......... Distance to nearest lot ..........
<br />Number of pits... ............ Lining material........ __..._... Size: Diameter. Dept'-) ................ •`
<br />Distance from nearest wellw..........». Distance from foundation ................ . Lining materiel ............. ..... .........
<br />,,. Depth_....... .Liquid Capacity..... gals: tC`-W
<br />S;zb: Diameter_._.............- ........... ..,..,....
<br />Distance from nearest wall.___.»...,_ ._..».._. _..,.....,......Distance from nearest building...............
<br />Distanceto nearest lot line... ..................... ..... _....,»....... ...........,...- .r ..,_.-.. .»..... _ .__......-.................... ..
<br />f ,c Ta k: 1
<br />Disposal Fieid:
<br />12%_
<br />Seepage Pit
<br />Cesspool:
<br />Priv11
<br />Remodeling and/or
<br />repairing (describe): „ . » ........ _..........
<br />. ... w ................ .......w ...........
<br />. _. ............ .................... ..,.» .....-. «...._._......._._...... .. ..,......................, ...__.. ,....._....................
<br />...................................... ..-.._.._..-.............................. _--_....__............. ......... ...._..........._........ _....................... ..._..._.._._ __..._...__..._.... .........
<br />I hereby certify -that I have prepared this application and that the, work will be done in accordance with San Joaquin County
<br />ordinances, 5tatj lawsiand rules and regulations of the San Joaquin Local Health Distrimi.
<br />C?u tielwsr
<br />(Signed) .............. ...�L r3 �-� >, ...............�''_ Cir--! r. j f ....... _ -� ( i Contractor)
<br />$y :..................... .....................................
<br />.._. ____.�.....�.-..��`�:.il.:�.. ,�..... ...._._._...{`fide)._._...!/?_ ......_................... ......._...._ .
<br />}Contra or
<br />(Plot plan, showing size of lot, location of system in rel tion/to wells, bullding�i, etc., can be placed on reverse side).
<br />FOR DEPARTMENT USE ONLY
<br />APPLICATION ACCEPTED BY _...._...».._......................--•-•-----..._..._. GATE.--- tA
<br />DATE --..6.......---..-----.- .......
<br />_._.........._......_._..
<br />REVIEWED BY_ ......................................... ..._
<br />.................._......_......_..._._ .•.._-__..._-..,..._..._._..........................,..
<br />BUILDINGPERMIT ISSUED ............ ...................... ___ .......... .,...... ................................... DATE_...--•.0......_...._..-------...--
<br />Alterationsand/or recommendatiions:.___....._...._ _ ... „_ ,...m ....................,....... .._--.-..._..._......................_._.___
<br />.......... ......... _........ .................. ........... ....................... .. ......_...._............ ..........».... .. � .. , ..... . .. »..,� .... w .... ......... �. .
<br />FINAL INSPECTION BY:..-. ..... ;�7e(7........-•---... � Date........... �....."� ..'�� ............_ ...._.. ,...,..
<br />SAN JOA,QUIN LOCAL HEALTH DISTRICT
<br />130 South American Street 300 Weft Oak Street 132 Sycamore Street M4 NwA "C" Street
<br />Stockton, California Lodi. California Manteca, California Tracy, California
<br />ES --9-2M 0-:,2 Revised W-2100
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