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APPLICATION FOR SANITATION PERMIT Permit No. .15�_E/1._ <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica*ion is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.., - -• ----------- -� A,/- _ _..._ <br /> / f ------------------------ •----- <br /> Owner's Name----.--- f e'.__.d:--� ---- � ------------ Phone------------- <br /> _.....-- •- -- ---------------•--------------_------------ - -- ---- -- <br /> Address ------ ---- ^ -----=-------------------------------------------------------------- <br /> ------------------------------- <br /> Contractor's Name_-------- ---------•---.. _-------- ---- ----•--•-------------------•-At ---------------- ----....--------------------------------- Phone--------------- - ------ <br /> Installation will serve: Residence ['3. APrtment House ❑ Commercial ❑ �Trailer Court ❑ Motel ❑ Othex ❑ <br /> Number of living units: __ ___ Number of bedrooms Number of baths . Lot Lot size ----/._3_� -- -- <br /> ------ <br /> � <br /> Water Supply: Public system [] Community system E] Private 2/Depth to Water Table _X, ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: d <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank:11 Distance from nearest well_________________Distance from foundation__._______._-------Material---------.__._____.________________.._.--------- <br /> ❑ No. of compartments---------- - ------- --Size-------- ------Liquid depth -------- ---------Capacity... <br /> Disposal Field: Distance from nearest eli----- - - ...Distance from foundation.- _.._.Distance to nearest lot line Of each li <br /> Length Len line---- <br /> ___`..___._._- <br /> �' � Number of lines----------- --- g-- �� Width of trench........ <br /> Type of filter material___ _ ___._ . epth of filter material________ .____Total length_____ ---___________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line____-_._________ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------.Depth--------------------------------- <br /> Cesspool: Distance from nearest ________Distance from foundation--------------------Lining material._._.________._____________________. <br /> Size: Diameter--------------------- -------------- -Depth-----,r. -- ------Liquid Capacity ------- -------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> [] Distance to nearest lot line-------------- --------`------- ---- ---------.... ..- ------------------------------------------ <br /> Remodeling and/or repairing (describe)--------- ---------------- --• -------- ----------- ------------------------------------- --------------••-----------•--------------------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ------ - --- - --- ----------------------------------------------------------- -----------(Owner and/or Contractor] <br /> By:..................................................­........-----------------------------------------------------------------------(Title)--------------------------------------- ------------ <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 /> APPLICATION ACCEPTED BY-- ----------------------------------------------------------------------------------------------._ DATE----- <br /> REVIEWED BY - -- ----- DATE----- <br /> BUILDING PERMIT fSSUED--------------------------------- ------ - - -r - DATE <br /> ------------------ - <br /> Alterations and/or recommendations:__________....... -----.------- <br /> ------------------------------------------------------- <br /> ------------------------------------------------------------------------ ----------- ---- -----------------------------------------------------------------------------•--•-•--•-------------------------- <br /> ------------ ------------------------------------------------- ------------------------------------------------------------------------------••-----•...._....._- -------------------------- <br /> ---------------------------------------------------------------• ---------------------------------------------------------------------------------- ----------------------------------- ---------------. -------- <br /> FINAL INSPECTION BY:----...........;........ Date-------- ------- .......-- <br /> SAN JOAQUIN 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 /> E5-9 145446 ATWODD <br />