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Permit No. <br /> APPLICATION FOR SANITATION PERMIT ------- <br /> (Complete in Duplicate) <br /> Date Issued -------lea. <br /> Applica4-ion is hereby made to the'San Joaquin Local Health District fora �,errnit t u ct n� ins. II or erein escribed. <br /> This application is made in compliaince with County Ordinance No. 549. <br /> OJ <br /> Owner's Name-----�CLLp� Phone---------------------------JOB ADDRESS AATI --- ----- -------- <br /> -------------------------------------------------------------- <br /> ------------ <br /> Address---------------------- ------------------------------------------------------------- ------- ................ --------------- ----------------------- <br /> PhoneContractor's Name---- --D___ --------vs,_�------ --- ------- ----------- ------- ------- Ph <br /> Installation will serve: Residence----ji�parlrnent House Commercial El Trailer Court ❑ Motel 0 Other <br /> Number of living units: --------- Number of bedrooms -------- Number of baths .---.--. Lot size ------- d'-ICA-4-2-------------------------- <br /> Water Supply: Public system [3 Community system El Private �Ipth to Water Table -------- ft. <br /> ----------------­*---- -------- ---I <br /> ------ --- ---Commercial 4part, rit House C <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] ClayE] Adobe Lg_-HarJpan [1 <br /> Previous Application Made: Yes ❑ No New Construction- Yes0-1<00 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> o septic tank or cesspool.'Permitted if public sewer is available within 200 feet.) <br /> SA14ic s Distance from nearest well--.--_----.-----Distance from foundation-------------------Material------------------------------------------------ <br /> No. of compartments--------------------------Size--------------------------------Liquid dep�-------- ---- --------Capacity----------------------- <br /> D' Distance from nearest welllhP'd----Distance from foondafio ---- 0--------Distance to nearest lot line.457 <br /> .., -_--,--_..-.Width of tre: <br /> Number of lines--- Length of each line-. 91-19 nch.,41;ce�'-------------------- \\I <br /> e...........Total length- IdLv--- -----------------­---- <br /> T;pe of filter material) _41 Depth of filter materia!___ <br /> Seepage Pit:. Dista;ce to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---_----_--_----_ `� <br /> ❑ <br /> ine----------------- <br /> F1 Number of pits-------------- -------Lining material-..-------------------.Size: Diameter-----------------------Depth..------------------------------- <br /> 1! . <br /> Cesspool: Distance frcm Inearesf well-----------------Disfance.from foundation....-.--..-.-------.Lining material--:_-_.-----_------------_-----_-. <br /> ❑ Size: Diamete.r----------------- ---------- -"-'----De�W--------------------------------------------------Liquid Capacity_-----_-------------- _gals, <br /> I T <br /> Privy- Distance from-,nearest we€l---------------------------:�:�------------------Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line------------------------------I -------------------------------- ------------------------------------------------------------------------------ <br /> Remodeling and/or' repairing (describe):-------------------------------------- ----------------:--------------------------------------------------------------------------------------------------- <br /> --------------------------- -------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- ------------------ <br /> - --------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- <br /> I +i <br /> -- __ -------- -, ---------------- <br /> ------------------------- ------------------- --------------------------------------------------------------------------------------------------­­ ---- -----------­-----------------­­: <br /> I hereby certify that I have prepared this application and that the work will be done in accord nce with San Joaquin y <br /> ordinances, State laws'. and rules and regulations of the San Joaquin Local Health District. <br /> DAY&NIGHT <br /> (Signed)--- --------------Septic,"-tank-SwAce----------------------- --r--- -------- -------- -- ------------------------ -- ------ -L0*%s*maaid/,oiL-Contractor) <br /> 1206 So.Eldorado NO 2-7046 <br /> Byvi ------------------- -- ---- ------- ----------------- ------------------- <br /> 3 is-ekton;-� If--------------------------------- --- --- <br /> (Plot plan. showing size of I loca!tion.o system in relation 1 611s, buildings, et ., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> or, n, V <br /> .. . . ... <br /> .2 'g, <br /> j f <br /> - <br /> b buildings, <br /> APPLICATION ACCEPTED BY-------- - ------- --------- -1- ---------------------------------------- DATE -------- <br /> --------------- --------- <br /> REVIEWED BY---------------------------------------------------- N- ---------I------------ DATE --- ----------------- ------------- <br /> BUILDINGPERMITISSUED.---------------------------------- --------------------------------------------------------- DATE------ •------------11-1----------------------------------- <br /> Alterations and/or recommendations:----------Z—----------------------------------- ---- ------------- ------------------------------------------------------------------------ <br /> - ---------- <br /> 7:��_7-------------------- <br /> ----•---•--------•• ............ ............ <br /> ---------------------------------------- -------------------k-------------- ------------------------------------ ------ ------ --------------------------------------------------------------------------------------------------- <br /> ---------------- --------------:-------------------------I-------------------------------------------------------------------L -------------------------------------------------------------------------------------------- <br /> ------------ ------------------------ ------------------------------------ ---------------------------------------------------------------------------------------------- •------.------ -.. --------------------- <br /> FINALINSPECTION BY----------------- -- ------------------------------------ Date-..--- -.J-.-------.--`- ------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />