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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Applica4-ion is hereby made to fhe-sanJoaquin Local Health District fora permit to construct and install the work herein described. <br /> This application is made ini compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND L TIOIN---;_ou- <br /> Phone---- --------------- ..-- <br /> Address. <br /> . <br /> --------------------------------------- - <br /> Owner's Name-------•- -I1 _1 - --------- --------- <br /> Address-------------------------- -------- -- ------------------------------------------------------------ <br /> ------ --- ------ -----0---- ------ - -- ----------_------- <br /> ---- ----- - -- ------ --------- ---------_---------------- Phone----------------------------------- <br /> Contractor's Name---------A& <br /> 0 <br /> installation will serve: Residence P__Xpartment House [-] Commercial E] Trailer Court E] Motel E] Other E] <br /> Number of living units: ."l --- Number of bedrooms __2 Number of baths -__f__ Lot size ------ --------------­------- <br /> Water Supply: Public system 0 Community system El Private �bepth to Water Table,..,Y-- ft. <br /> Character of soil to a deptih. of 3 feet. , Sand E] Gravel E] Sandy Loam &-61a"y Loam.0 Clay E] Adobe El Hardpan El <br /> Previous Application Mad Yes E3 No fEr"New Construction: Yes 8-50"Ll <br /> TYPE OF INSTALLATION. AND.SPECIFICATIONS: <br /> _(Noseptic 1a-k26ndtirool-p_ermiffed-if-pUblic:ywer is availa6le-within200-feet;) <br /> Ilk- <br /> ... ... ............ <br /> Septic Tank: Distan4le from"nearest W %-3_99-----Distance from foundation .../4�-------Matepl--d-_6------ <br /> compartments------ -- --------- Size- W ----------Capacit ..-Acn6 45 <br /> No. A9---Liquid dep,fh----f.;7_ <br /> Disposal Field: Distance- from nearest well_k;;t_j(9.4 Distance from foundation-, ( __ Distance to nearest lot-line__1159 <br /> --------------- <br /> Al <br /> Number ol lines-------- ---------- Length of each line-. Width of trench --------------- <br /> Type of filter rnaferial-_/ A_L_Depfh of filter Material------2e---------Total length--------5-P-:P......................... <br /> ' <br /> Seepage Pit: Distan e. to nearest well_____________ ---.----Distance from foundation--------------------Distance to nearest lot Zine_______.-________ <br /> E1 Numbir of pits----------------------Lining material-----------------------Size: Diameter------------------.----Depth--------------------------------- <br /> Cesspool: <br /> epth---------------------------------Cesspool: Distance from nearest well-----------------Distance from foundation-----------_-------Lining material_______.._-__._____.___________-___Size: Diameter---------------- -------_ - -------De th----------------------------------------------------Liquid Capacity--------_------------------gals vlaw <br /> Privy: Distan e from nearest well --- --------------------------------------Distance from nearest building_____._____.________________.__._______ <br /> ElDistance to nearest lot iine-----------------------------I---------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repaiirij�ng (describe):-------- ---72le!k .... .. <br /> ----------------------------------I---------------------------------------------------- <br /> ----------�-­...... ---------------------------- <br /> -------------------------------------- ------------------------------------------------------- -------------------------------------- ---------- <br /> ­­­-------------------- ­-------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - -- ------------------------------- ------!II!----------------------------•------------------------------------------- <br /> , <br /> I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws. aiii 'rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------- -Contractor] <br /> -- --------------- -------------- ------------------------ <br /> B —----------- ---------�_n-------------- <br /> ---------------- <br /> -- -- - ---- ----- <br /> m <br /> m <br /> m <br /> ;io m------- <br /> (Plot plan, showing size location sistem in relafion to wells, buildings, etc., can be placed an reverse e). <br /> 01-lot, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------. -------- -------------_--------- ------------------------------------------------- D A T E_=4L;W------------------ --------------------------- <br /> REVIEWEDBY------------------1-------------- ---- ---- ---------------- - ---------------------------------------------- DATE---V -----------------------­------------------------ <br /> 91F <br /> BUILDINGPERMIT .ISSUED------------_- ----------------------------------------------------------------------------- DATE-------Z------------------------------------------------- <br /> 1111 , <br /> Alterationsand/or recommendations:------------------------ ---------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- ----------------------------------------------I--------------------------------------------------------------------- --------------------------------I--------- .......­------- <br /> ------------------------------------...... ---------------------------------------------------------------------*---------------------------------------------------------------------------------------------------------- <br /> -------------------------- -------1­ -------o.......................... ----------------------------- I---------­---- - ----------------------------------------------------------------------------------------- <br /> -------------------------------------------- -------- ----------- --- ------ -- - - -- --------------------- --------------•---------- ------------- ---------- --------------­------------•----•----------- <br /> -_-,-,-- FINAL <br /> -----------­­------------------------------ <br /> -_-,-,-­FINAL INSPECTION BY------------------ -(-------- ------------ - ------••---• Date.------------- -------- ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfreef 300 West Oak Street 132 Sycarnore"Sfreef 814 North "C" Sfreof <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5_9_ZM 145446 ATWODD 12-54 <br />