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APPLICATION FOR SANITATION PERMIT Permit <br /> ---------------- <br /> (Complete in Duplicate) <br /> Date Issued -----S.� <br /> giA <br /> plication is hereby made to the San Joaquin Local Health District for a permit to'construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__0,0 --------%_____ . amj_ti---------------------------------------- ----------------- -- ------------------------i--------- .............. <br /> ------------------- Phone------------------------------------- <br /> Owner's Name ---- --- --- -------- <br /> ------ --------------- ------------------ <br /> Address ------------ •---- --- <br /> I <br /> Name------------------ -- --------- ------------------------------------------- -- ---------- -- --------------- ----------------------- Phone----------------------------------- <br /> Installation will serve: Residence X - partment House [] Commercial [] Trailer Court E] Motel E] Other E] <br /> Number of living units: - u A& - - <br /> Number of bedrooms __,-Number of baths ---1--- Lot size ------- <br /> -------------------------- <br /> Water Supply: Public system E] Community system [] Private Depth to Water Table --10- ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam E] Clay Loam 0 Clay 0 Adobe A' Hardpan 11 <br /> Previous Application Made: Yes El No, New Construction: YesA No E] <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____ b__ Distance fcom found, t, n---- L--"-----MatV-aJ--------—----Z7 <br /> P.;Ip <br /> No, of compartments------- _.Size_____- Liquid depth______ <br /> _-Capacity---- <br /> ............. ------- <br /> Dis o al Field: Distance from nearest 11 Distance from foundation--- to nearest lot 1pe----4-------- <br /> Length of each line,1�2. . ....Width of trench.._._ ?`"`______________ <br /> -W--------------- <br /> - 5 Number of lines___.___,_ <br /> Type of filter material-----41��Depth of filter material-----49 ef... <br /> ----Total length--------/,0?----------------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation___-___________---. Distance to nearest lot line____.________.__ <br /> ------------- <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------.___-Depth--------------------------.-.-_-- <br /> Cesspool: <br /> epth-----7--------------------------- <br /> Cesspool- Distance from nearest well-________________Distance from foundation____-______--__--- Lining material______-______________________________ <br /> ❑ <br /> aterial------------------------------------- <br /> El Size: Diameter---------------------- ----------------Depth----------------------------------------- ------Liquid Capacity---------------------------gal <br /> s. <br /> Privy. DIsTance'from* nearest well_-'________________________________-____--__,._Distance from nearest building_..__-____- ______________ --------- <br /> El Distance,fo nearest lot line ...... ---------------------------------------------------------------------------------------------------------------- ------ <br /> Remodeling and/or repairing fdesc ..... - ------------------------- ...... <br /> A144---------------- <br /> ----------- ------ ------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- <br /> -------------------- --------------­----------------------------------------------------------- ...........­------------------------------------------------------------:---------------------------- <br /> j: --------------- <br /> ----------------- -------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- County I hereby certify that I have prepaied this application and'fhat the work will'6e done in accordance with San"JoaA6in <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> :----------------------------------------------------------------------------------------------------(Owner an d/or Contractor) <br /> -------------------------­- <br /> -------------- <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 /> -------------------- <br /> REVIEWED BY------------------------------ ---- 3 ------------------ <br /> ----------------_ DATE------- <br /> MIT ISSUED------------------------------------------------ - - -- -------------------------------------- DATE.------------------------------------------------------------ <br /> BUILDING PER <br /> Alterationsand/or re corn menclatio ns:------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------_,_----------­-------------- <br /> --------------I——------------------------------------------------------ -----1-------------------------- --------------------------­­­-------------------------------------------------------------------------------- <br /> ------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------- --------------------------------<----------- ------- ------ --------------------------------------------------------------------------------------------------------------------------FINAL INSPECTION BY---------------- Date---------------Co- ------- ------------------------------------ <br /> _ ---------------- ------------- <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 /> ES-9-2M 10-52 Revised W-21100 <br />