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APPLICATION FOR SANITATION PERMIT Permit No. . .[0 .Q..S <br /> (Complete in Duplicate) / l <br /> Date Issued .__.___ 1.1 .5 ,3 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t work eryr ibe <br /> This application is made in complian with County Ordinance No. 549. <br /> JOB ADDRESS A L ATI <br /> Owner's N e -- _ -- 710 — <br /> ...... <br /> y ------------ - ------------------------- --------------------- ------------------. Phone._�t_--6..q--- <br /> -- <br /> Address..... 1 -0'– <br /> Contractor's Name--- --••--.---•-•--- Phone <br /> Installation will serve: Residence Apartment House ❑ Crmercial ❑ Trailer Court ❑ tel ❑ Other ❑ <br /> -_�[.Number of living units: --- Number Number of bedrooms Number of baths ._�(-__: Lot size --- ____________________________-------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [d tepth to Water Table ------- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe[0'/Hardpan ❑ <br /> Previous Application Made: Yes ❑ No /—New Construction: Yes /No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: C * <br /> (No septic tank or cesspool permitted if pubic sower is avaj[able w th�'In,20 fe�.) <br /> Septic ank: Distance from nearest w I�__ ._.. Dista ro foundation------_.___.__...Mater' �_----------------- ---__---- ------------- <br /> No. <br /> -_ ._ <br /> - No. of compartments-----.�..--__-- .-r_--��--��±S��i e-- ---------- -��.---Liquid _de�p�th�--�-- --------------Capacity---•�1,��--- <br /> Dispos Field: Distance from nearest w II �_!!"�Distance from foundation/ ��y!Distance to nearest to li C� <br /> - <br /> ------- <br /> Number of lines___________ _____ __________ ,Length of each line__'`f.'�_."_ _ Width of trench---------- .. ..._ <br /> -- <br /> Type of filter materi . . --��^�._____ pth of filter material---------- ---- - Total length---------- . -----__- _. <br /> Seepage Pit: Distance to nearest well_.--------------------Distance from foundation....................Distance to nearest lot line_---__._.--_-.-: <br /> ❑ Number of pits----------------------Lining material......-----------------Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> F-1 Size: Diameter------------------------------------Depth----------------------------------------------------Liquid Capacity-------_--------------•---gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------_•..._._-._-___._. <br /> ❑ Distance to nearest lot line------------------------••---------------------------------------------------------------------------•----------- •---------------- <br /> Reod ing nd/or,repairi (d s ibe :----------------------------------------------------------------------------------------------------------------- ..................................... <br /> -Vel '4'--- - ----- - ------ ------------------------_------------•--------------------......--------------------- -------- --------------------------------------------.-_------ <br /> ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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, rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---- t... <br /> V- ---- ------------------------------------------------------------------------------------------------------------(Owner and/or Contractor)�.. <br /> By:------------------------------------------------------------------------------------------------------------------------------------(Title)-----------------------------=----------------- <br /> --------------- <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 /> REVIEWEDBY---------------------- ------ •-- - -----------------I----------------------------------------------------------------- DATE -A�` <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------- ------ DATE---------L ------- <br /> Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------------------•-------------------------------------- <br /> ----------------------------------------------------------------------------------- ------------------------------------------------••--•---------------•---••••---••--•-----------•--•--•-•-----••----------------------- <br /> ----------------------- ------------ --------------------------------------------------------- ---------------------------------------------------------•---------------••--•----•--•-•----------------------------------•- <br /> ------------- ----- ------------------ ----­------- <br /> 1/1 IZ7 <br /> FINAL INSPECTION BY------------------- ------------------------------------------- Date---- <br /> /9-7 �/-—--------------------- <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 0-52 Revised W-2100 <br />