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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date issued 0 _. � <br /> Application 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 Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION -1-- ------j--!-Vj!- <br /> er A---- -------- ----- ------------------- ------- - ---------- -------- <br /> Own r's Name-,I ----------------------------- <br /> ot-----S Phone.Address---------- ........ - ---------------- -----/- --- --------- ------------------------------------------------------------------------------------------- <br /> Contractor's Name------------------------ - -- ------- -- ----------- -- ----------------------T----------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence x Ap ment House E] Commercial 0 Trailer Court E] Motel [I Other E] <br /> Number of living units: --I---- Number of bedrooms . VNumber of baths -__I--- Lot size-----7_ i-At ---0______________________ <br /> Wafer Supply: Public system 0 Community system Ej Private A Depth to Water Table 6-0 ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ] Sandy Loam L] Clay Loam D Clay ❑ Adobe Hardpan <br /> Previous Application Made: Ye4 No <br /> A New Construction: Yes D< No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se f' Tank: Distance from nearest well 4&7-'-Dista c f f ion----- Mat <br /> y yen -------------- - ------- <br /> No, of compartments----- <br /> Alle-------------Si Y, ___Liquid depth_-.-.-.__ ----------Capacify­k- <br /> Diwl Field: Distance from near st well-106-t-Distance from founda 0 42001 Distance to nearest lotjlipe---Z- <br /> A, 411k trench..__.- <br /> t <br /> Number of lines--- --------------- Length of each line-- ..7M- cbTWidfh of fre - ------------------ <br /> or M- <br /> Type T filter material-rr�-P_-__-_ _-Depth of filter material--/g-----------Total length------41-0-------------........ <br /> Z T I <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------ -------- <br /> ❑ Number of pits---------------------Lining material.......................Size: Diameter-----------------------Depth--- ------ -------- ----i <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------L <br /> F1 Size; Diameter----------------------------- Depth--------------------------- Li uid Capa ity-, <br /> Privy: Distance from nearest well__________________ - <br /> istan n from nearest building_____..__..__.._.__.__________ <br /> E - -------- <br /> --- <br /> Distance to nearest lot line------- --------------------- -- <br /> em deling and/or pairing (describe).­1-;-L- ---/6'-;y. - — --- -'--- --- --- -- ------ ---- - <br /> -- --------------------------------------- <br /> - -- - -------- ---------------------------- ..tTft------e------------------------------------------------------------------------------- <br /> ------------ -------------------------------------------------------------------------- ------------------------------------------------------------------------------------- ----4 <br /> 1 hereby ce that I `ave pr ared this application and that the work will be done in accordance with San Joaquin 60U <br /> ordinances, Sfa aws d ules d regulafi s of the San Joaquin Local Health District. <br /> (Signed)-........ - -- -- ------a --------- -- --- ----------------------------I---------------------------------------- -------------- -----------------------{Owner and/or Contractor) <br /> By-------------------------------------------:- -----------------------------------------------------------------------------------{Title)_ - - ------- ------- <br /> (Plot plan, showing size of lot, Iota- of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------- Y,--------I------------------------------- DATE------------------------------ ----------- <br /> REVIEWED BY ---- ---- <br /> ------------------------------------------ - , - --- - e-- ----- ---- -------------------------- DATE <br /> BUILDING PERMIT ISSUED---------------- CN -- --X ---- ---- ------------------------ DATE---- ----------------------------- <br /> ---------- -A- 1-1-- ---- ---------------------- <br /> Alterations and/or..recommendations------------/--#-------- <br /> ---'7------------------------...... -------- <br /> ------------ "ii--—-------------------- <br /> - ----------- ­ ----- - <br /> ---------- --- ----f_ __te--------- <br /> U, <br /> 'ev 74 f <br /> ---------------- ----------- ------ <br /> -- - ------- ---- <br /> ---------------- --------- -------------------------- - ----- ------ ------- <br /> AL INSP Date----- ........ <br /> F N BY:.......... /477!. ------------------ <br /> <:ap- ------------------ <br /> tR5 /V . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-7-2M io-52 Revised W-2100 IJ <br />