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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 Ord' rice No. 549. <br /> ----------- --- --- <br /> (_eaye-1_9---- <br /> JOB ADDRESS D LOC I Phone------ ------ ---- ----- <br /> - - -------------- ---------- ---- ---- ------- --- <br /> Owner's Name---- - -- -- ----- -- -------- -- --- -- - ----- ----------------- ----- -- <br /> ------------------_------- <br /> - ----- -------- ----- ---- - ---I-- ------------- - -------------- -----------••----------------•-------I-------------•--- <br /> - <br /> ­------------------------I------------------ <br /> Address-_------------------- --- _------------------------- <br /> Contractor's Name----------------- -------------- -_---------------------------------------------------------- <br /> ----Installation will serve: Resident rtment'House El Commercial E] Trailer Court ❑I ofel E] Other El <br /> rooms Number of,baths IZAG_tsil .. .. A --------- ----------------- <br /> 4---- <br /> Number of living units. Number of bed le <br /> Water Supply: Public system El Community system ❑ Private Depth to Water Tab <br /> Character of soil to a depth of 3 feet: Sand E] Gravel C] Sancly�L am E] Clay Loam El lay ❑ Adobe Hardpan <br /> 0, <br /> ❑ <br /> f <br /> lav r- <br /> Previous Application Made: Yes El No � New Construction: Yes, No E] 4-y" <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: . /et.) <br /> (No septic tank or cesspool permitted if public sewer is available within 200 r et.) <br /> Septic Tank: Distance from nearest well--------------__Distance from foundation-------------------Material-_.-_-_-.--_.-.--_.__._--_____.._._____._._._.. <br /> No, of compartments-- .--------- -----------Size Size---------------------------------------------------Liquid depth--------------------------Capacity----------------------- <br /> ❑ <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation-----------------...Distance to nearest lot line----------- <br /> El Number of lines---------------- - ---------------Length of each line-----------------------------Width of trench.---------------------------------- <br /> Type of filter material------------------------Depth of filter material-----.---------------Total length-----------------------------------------/7- <br /> D�stance to nearest jell ---90. istance fro ifoundoatTion--/--'o-o-.-�0.16sta to nearest lo e <br /> Seepage Pit: ia mete r-_6__x -------- <br /> A46a e. Depth------?----- -- -- <br /> Number of pits------ - ------Lining material/ <br /> C<1'S!0oi: Distance from nearest well-----------------Distance from foundation.__--_....__-_--- Lining material__.-_--_.---___- ------------------ <br /> .gals.. , <br /> Deoh....................I--------- .....--- ----Li --------= --------------- <br /> _q��id,C��?aci, -------- <br /> r- _.. _Dep}h Diameter <br /> Distance from nearest well--------------------------- <br /> ----------------------Distance from nearest building------------------------------------------ <br /> Distanceto nearest lot line--------_--------- --------- -------------------------------------------------------------- ----------------------------------------------- <br /> Remodeling and/or repairing (describe}------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------- --------------------I-------- --------------- ----------------------------------------------------------------------------------------- ------------------------- <br /> -------------------------------- ----------------------------------------------------------------------7---­--------------------------------------------------------------------------------------------------------------- <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)--- --------------------------------------------------------------------------------- -------- ----------------------------------------- <br /> -._---(Owner and/or Contractor) <br /> By:__-----------_----------------------------------------------------------------------------------------------------------------(Title)-----------------------I---------------------- <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 /> 7 <br /> — --------------------- <br /> BUILDING <br /> --------------------BUILDING PERMIT ISSUED------------------------------ DATE--------- --------- -------- -- ------- --------------- <br /> Alterations and/or--r-e--c--o--m---m---e--n-d--a--t--i-o--n--s-:I----------------.-.-.-..-......... ..------------------------------------------------------------------------------------------------------------- <br /> . - ------------------------------------- <br /> -­--------------- <br /> -----------------------------------------------.--.-.-.-.-.--------------------------------------- - ------P- <br /> ------------ -------- --------------------------- ----------- ------------I-------------------------------------------------------------------------------------------------------------------------------------- <br /> - <br /> ---------------------------------------------------- .. ..... ..... - I <br /> ---- ---------------------------------------1-.. <br /> .... ------- ------- <br /> ---------- - ------------------- ------ ..........---.......-- ------------- <br /> ---------------- <br /> ------------- <br /> -------------- -------------------'t 1 ---- --. opa- -- ..... <br /> .. <br /> FINAL INSPECTION BY:-------- - ---- ------ - ----- - Date.. --------- ----------------- <br /> SAM AnAQUIN LOCAL HEALTHDISTRICT <br /> - <br /> 300 West Oak Street 132 Sycamore Street 914 North "C" Street <br /> 130 South American Street <br /> TracCalifornia <br /> Stockton, California 1, Manteca, California y, <br /> Lodi, California M <br /> E5--9-2M 146446 AVWD?D 17-54 1, <br />