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APPLICATION FOR SANITATION PERMIT Permit No. ...... <br /> (Complete in Duplicate) Date Issued <br /> Applica�ion 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 Ordina ce No. 549. <br /> ---------------------- 7 ------- <br /> JOB ADDRESS AND,bOCATIONt�. O.-m-6-1 4;v <br /> 10, Phone---------- - ----- <br /> Owner's,Name ---- —­_e------- -�__. <br /> - ------------_--- -------- <br /> -------------*--------- -----------------*---------------------------- -------- <br /> Address----- F 1/7 --------- ------------ Phone------•-----------------•-------- <br /> Contractor s <br /> hone----------------------------------- <br /> Contractor's Name-------------- <br /> Installation <br /> ame-------------- ------ ----------- -------V <br /> -------- --------------------------------- Other El <br /> Installation will serve: lResidence artment House [I Commercial El Trailer Court 01 Motel El <br /> ---------- <br /> Number of living units: Number of bedrooms -------- Number of baths -------- Lol" size ------ <br /> Water Supply: Public system ❑ Community system-E] Private E] Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand El Gravel [I Sandy Loam El Clay Loam 0 Clay Adobe EN, Hardpan 0 <br /> Previous Application Made: Yes 0 N New Construction- Yes No 0 1 <br /> 0` � <br /> TYPE OF INSTALLATION AND SPECIF�ICATIONS: <br /> et is available within 200 feet.11 <br /> (No septic tank or cesspool permitted if,public s '5 y <br /> 1�tace ---- ----- aterial----------------------------- ------------------ <br /> tan <br /> Distance from nearest well..,Septic Tank S. .-Capacity---V---------------- <br /> ze...... <br /> No. of compartments___________--- ------I ..Size-------------------- Liquid depth.---------------------- <br /> 4 nearest well_.-_.--..___--------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑D-4sposal Field: Distance from n Number of lines-------------------- ----- ----Length of each line-----------------------------Vidth of trench----------------------------------- <br /> - -- <br /> Type of filter material--------- ----------. ..-Depth of filter material--------__-------- Totai length__...___..__.____..____._.._____._______. <br /> nearest well---.--------- --------Distance from foundation------------------_Distance to nearest lot line----------------- <br /> Seepage Pit: Distance to near inmaterial-.---------------=----;Size: Diameter------------- -------- <br /> Depth----------------------- --------- <br /> Number of pits--------------- ____Li <br /> El - t "4Disf,ince fro foundation._.----- Lining maferial-------4-4...-A- --------- <br /> Distance from nearest <br /> ---------------Liquid_Capacity, - " --------qals. <br /> -----Depth---- <br /> Cesspool: Size: Diameter. -w I <br /> D�stance from nearest building------------- ------------------ --------- <br /> Privy: Distance from nearest well_____....------------------------------- -------------------------------------- <br /> 0 Distance to nearest lot line'r- ----------------------------------------- ------------------------- ------------------------------- <br /> Remodeling and/or repairing (describe)_____________________..__--_._._----- .------- <br /> ---•------------------------------------------- --------------------•--- <br /> --------------------- <br /> --------------------------------------------- ---------------- <br /> ---------------------------------­---------------------------------------------------------------------------------------------- ---------------------- <br /> ----- - - - ------- --- ­ - - ­ ____ - <br /> ---------I -e-6-y.-certi-fy_.th-a-t__I__have__p I irepared this application and that the work will be done in accordance with San Joaquin County <br /> nd regulations of the San Joaquin Local Health District. <br /> ordinances, State laws, and rules a <br /> for) <br /> or Co -a"------- <br /> (Title)--- <br /> k (Sig ------ ---------- ------------------------------------­------------------------- <br /> ----------(Owner and/or Contractor) <br /> ----------------------------------------------(Title)--- ------------------------------------------------------------ <br /> By:------------------------------------------------------------------- ----------------- -stl ) <br /> (Plot plan..skowinq size of-lot,-Ip-cafion-of . st.em-in-relatio.n,tow6lls,,.buildings, efc.,.can be <br /> -placed,,on-reveirseie. <br /> .,sy <br /> FOR DEPARTMENT USE ONLY <br /> tDATE------------------ ------------ <br /> APPLICATION ACCEPTED BY_--------- - ----------- --------- ------- ----------- --------------------- DATE /4 ---- <br /> <1----------- <br /> REVIEWED BY------------------------------------- ....... ..... �A <br /> ------------------------------ <br /> BUILDING ---------------------- <br /> PERMIT ISSUED--------------------------------- ------------------------------ <br /> ----------- ------------ ---------------------------------------------------------------- <br /> Alterations and/or recommendations ----------------------------------------I-------- <br /> ---- - -------------------------- <br /> -------------------;- <br /> ------------------------------------- ------ -- .-----------------•----•--•---------------•------ ------------------------------------------------------I--------------- <br /> ------ ----------------------------I----------------- -- - --- - - -- ------------------ ------------------ ------------------ ..........I------------------------------------ ------------------------------------- <br /> -- ---------------------------- -------I .........I ------------------ ------------------- ---------------------------------------------- <br /> ----------------- ----------------------I------------------------------- -- --- ---- --------- -------------------------------- ---------__------- <br /> -------------- <br /> FINALINSPECTION BY:------ -------- I - -------------- --- -------- ----- Date.- �------------- ------------ -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street <br /> TracC <br /> Stockton, California Lodi, California Manteca, California y. California <br /> ES-9-ZM 145446 AYWOUD <br />