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I APPLICATION FOR SANITATION PERMIT Permit No. .___.. b__' ___ <br /> (Complete in Duplicate) f/_i/4 Date Issued ---------------------153 <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. <br /> JOB ADDRESS AND//LOCATION +----�.------ ----�--`�--�---•-•------ ---------------•-- <br /> Owner's -- - -- ------ Phone <br /> ----------- <br /> Address. '-------- / .�_. �---- ---------�-- �'�-�---•----------------------- ------------------`--,---/--------------------•--••----- <br /> Contractor's Name- �.P` - ------- ------� 7-----------•-------------•-•--------------------------•----•--. Phone_ -d�.Z6.------------- <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑f Motel ❑ Other ❑ <br /> ]`lumber of living units: -/-- Number of bedrooms ___ Number of baths -_-/_ Lot size <br /> s <br /> Water Supply: Public systein ❑ Community system ❑ "Private fo Depth to Water Table__ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobeo Hardpan ❑ <br /> Previous Application Made: Yes ❑ No N 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 /> Septic Tank: Distance from nearest well gQ _.-__Distance from foundation____�4-_.______.Material_________________________________________________ <br /> No, of compartments------- --------------Size_9xyQX- ----------_Liquid depth----1!1- -----------Capacity- <br /> Disposal Field: Distance from nearest well_9'0..__._._Distance from foundation---- <br /> to nearest lot line---------- <br /> � LengNumber of lines---._____ _------------------------ <br /> th of each line- �d-------------------Width of trench------���------------------------ <br /> Type of filter material--��__1R0'_4-'---Depth of filter material_._----g._11--------Total length---------4_a_-__________________ <br /> ---.. <br /> S ,Pit: Distance to nearest well_____________________Distance from foundation------------------- Distance to nearest lot line__.______.__._._ <br /> Number of pits-----------------------Lining material---------•-------------Size: Diameter-----------------------Depth--------------- ------------------ <br /> Ces pool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_.______-_---______._._ <br /> ::} ❑ Size: Diameter--------------------------------------Depth--------------------------------------------- ---Liquid Capacity------------------ -------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building___---.______._.____--__----------------. <br /> ❑ Distance to nearest lot IineF--------------------------------------------------------------------- ----------------------- <br /> Remodeling and/or repairing (describe)----------------------------------------------------------------------------------'lr,` <br /> t <br /> i. <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed).._-- if ' Zner o Contractor) <br /> and/or r Contr ) <br /> By: - --------------------------------------------(Title) -- --------- <br /> (Plot plan, showing size of lot, location of sysf6m in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> a APPLICATION,ACCEPTED BY----- - - ------------------ - - -- " DATE------- �� fG" .3 <br /> REVIEWEDBY - -------------------------------------- .­--------------- ------- DATE--------------------. <br /> 1 DIN PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ ----------------------------------------------------- <br /> Alterations and/or recommendations----------------------- -------------•--------- <br /> -----------------------------------------•-•------------------------------------------ --- -------- ------------------------------------------------------------------------------------ •-----••--•--------------- <br /> -------------- ----------------- -------------------------------------------------------------------------• --------------------------------•--------------------------•--- <br /> 1 <br /> FINAL INSPECTION BY----------------- ' � Date------- �� <br /> SAN JOAOUIN 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 10-52 Revised W-2100 <br />