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jo <br /> S _- �_ `-- ---- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> i (Complete in Duplicate) <br /> Date Issued <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 OrdinancLs-No. 549. <br /> - I! <br /> JOB ADDRESS -ND LOCATIONS Z;t - ---------- -----% --------------- cc <br /> Owner's Name --- ---------- '�' - ---------- -- --- --- ------------------------ -------------------------------------------- <br /> Phone__ " -- -- <br /> Address------------ ---= ----&- ---------------- -------------------------------------------------------------•----------------------------------------------------------- <br /> Contractor's Name - --- ------------- ----------------------------------------C <br /> ------------------------------------------------------------------------------------------------=------ Phone----------------------------------- <br /> dl <br /> Installation will serve: Residence Apartment House E] Commercial E] Trail Court ❑ Motel ❑ Other E]Number of living units: __ ___ Number of bedrooms A__ Number of baths __1-___ Lot size _- �_____�_� __________________________.. <br /> Water Supply: Public system Community system '❑ Private ❑ Depth to Water Table ft, <br /> Character of soil to a depth of 3 feet: Sand E]: Gravel E] Sandy Loam Clay Loam Clay E] Adobe E] Hardpan❑ <br /> " Previous Application Made! Yes E] No ®� New Construction: Yes [ No ❑ <br /> TYPE OF INSTALLATION'AND SPECIFICATIONS: <br /> {No septic tank or cesspool permitted if public sewer is available within 200 feet..)) <br /> Septic ank. Distanee from nearest weil____--7----__Dista e fr m foodation___/�!--------- <br /> Mater i sl__ _________ -------------- _____________- .v <br /> =t No. oVcompartmenis______.__-- -_ __ ______Li Liquid de / Capa y <br /> Size: _ q p ---------- ------ p Y �d <br /> Disposal Field: Distance from nearest w,II___ Distance from foundati n__- j----- Distance to nearest' lot in�j_ __ <br /> [[ Number of lines_____ _____ _ __ Length of each line__ ___!lr 1 __.Width of trench_______ __ _ _ <br /> 7' ------------- <br /> Type of filter materia __ _ epth of filter material________ _ _________Total length____________ _- -_-:__--------_____ �. <br /> p g 1 <br /> -� e to nearest well----------------------D'sstance from foundation-------------------.Distance to nearest lot line----_-_____._____ <br /> Seel e Pit: Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---_----------------Lining material_,_______________________________._. <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from -nearest well ______________---_______ g-------------------------- <br /> ________________________Distance from nearest building----------------------------------------- <br /> ❑ Distanee to nearest lot line---------------------------------------------------------------------------------------------------------------------•-------------------- <br /> il <br /> Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> i° -----------•------•-=----------------------------------=-- <br /> ------------------------------------------------------------------------------------------------­- <br /> 11 <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 re ulations of the San Joaquin Local Health District. <br /> f ----- <br /> (Signed) al. - --- -------- --------------------------------- -------------------------------{Owner and/or Contractor) <br /> B--- --- - Title ---------------- <br /> Plot la , showin size of�-------••-------------------------------•- -- --- --- ----------------------------- ------- - <br /> - ----------------------------------------------- <br /> ( p g ,lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> � 4 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY---- -----------------------------•------------------------------------------- DATE,,—_ ----------------------- --- ----------- { <br /> REVIEWED BY----------------- -� DATE--.___--- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------- -------------------------------------- DATE----------- - __ <br /> �,Alterations and/or recommendations-- -------------- --------------------------------------------------------------- ---------------------------- ---------•-------------- ---------------- <br /> Ip. <br /> !I -------------------------------- <br /> I-------------------------------------------11------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ( ! <br /> FINAL INSPECTION BY:____- - _ ------------------- Date----- __ / -1/-_- <br /> Ir <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 8-51 Revised W,2100 <br />