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APPLICATION FOR SANITATION PERMIT Permit No. <br /> -4 (Complete in Duplicate) Date Issued ... <br /> Application is hereby made to the San Joaquin Local Health District for a perrnit 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 <br /> "t V,;v <br /> Owner's Name------- ... .. <br /> Address--------- -Sl` <br /> - - ------ ---- ------------ <br /> ............ <br /> Contractor Name ---xv -------- -------------------------------------- <br /> ------ ---- --1----- <br /> Installation will serve: Residence ----- ----- -------- ------- -- Phone-- <br /> X Apartment House E] Commercial 0 Trailer Court F] Motel El Other El----/---------- <br /> Number of living units: .1----- Number of bedrooms -1-- Number of baths Lot size .-._.6-( Y. / c" 6, -- <br /> Water Supply: Public system E3 Community sysfem E] PrivafeW Depth to Water TabI❑ <br /> e 41e�nf. ­ �------------- ---------- <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel Ej Sandy Loam [j Clay)Loam El Clay El Adobe Hardpan E] <br /> Previous Application Made: yes [I No El New Construction: Yes E] No E] <br /> TYPE OF INSTALLATION AND SPEC I FICATIO NS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T k: Distance from nearest well--._-.----------Distance from foundation_-._-._---_____- <br /> LEtt of con-parfmen[s. .. ... . ..... ....S,ze _ Materia!_--_--____-___ ------------ -------- <br /> ------ ----Liquid depth--- ------- ------------ Capacity----- - ------ ------- <br /> DisposalField: Distance from nearest well 0m w <br /> Number oflines------- - ----- ---Distance from <br /> foundation--------- __-_-..--Distance to nearest lot <br /> line._... ._- --.\ <br /> Type of filter material- -­ Length of each line.----_ ------------------Width of french-...... <br /> ---------- Depth of filter material------------- -------------­-­. <br /> ----- -- -Total length---------_---_-------- <br /> Seepage Pit: Distance to nearest well ....... <br /> Pr ---from foundation._ C__':- <br /> --------- D*,sfance to nearest lot fine. <br /> - ---------------D�stance <br /> Pr Number of its. S. <br /> Size: Dlarnefer.-5.3­11 Depth <br /> Cesspool: Dist�nnce from nearest well-----------------Distance from fOUnddf' - - ------ ----- <br /> El Size: Diameter----._------ <br /> - <br /> iarnefer.---- ----- foundation. ------ -- Lining material.-------.,_-- <br /> Privy: D�si6rc9 from nearest well ------ ------ - --- ­Liquid Capacity------------------- ......gals. <br /> --Distance fror, <br /> Distance to nearest lot line nearest b0ding--- -- ------ --- <br /> - ------- ------------ <br /> Remodeling ancl/or repairing (describe):------- --------- -- -- ------------------- - - ----------- - <br /> -------------­-------------------------------------------------I---- ----------­------------------- --------------------­ <br /> --------------------------------------------- --------------------------------I- ------------------------------------------------------------------ ----------- --- ..........................­ <br /> ­------------------------ ----------I----------------------------------------------------------------------------- ------------- ------------ <br /> -------- ----------------- --------------------------------------------------------------I-------------- ----- ------------- --- <br /> ---------- ---- ------- ------ ----------------------------------------------------------------------------------------------------I--------- ------------------------------------------ ------- - <br /> I hereby certify that I have prepaFq this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State lav"t, and rules and regulations of the San,Joaquin Local Health District. <br /> (Signed)----------- <br /> By:----- <br /> --------------------------------------------------------- -- ---- ------ ---- - 0 Contractor <br /> n ) <br /> (Plot plan, showing size of lot, location of system i --------relaf!1�to wells, buildi- ----/--------- ---------------- - <br /> ­ ....... ... - ------ -- --- <br /> Title <br /> ngi, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- <br /> REVIEWEDBY..--.- <br /> BUILDING <br /> - - ............ . ." --:-- ------------------------ --------- DATE----,-- ­�----------------­ <br /> -- --------- <br /> BUILDING PERMIT ISSUED- ---- -------- - ------------------------------------- DATE— <br /> ---------1 ------------------ <br /> ------------------ ------ -------- <br /> Alterations and/or recommendations:,------ DATE--/-..--.. ------ ­­ -------------- <br /> - <br /> ----------------- ------------------------------ -------- <br /> ------- --- ...... -------------------------------------------------------------------------- ------- ---- --- ---- <br /> ---------------------- -------------------------- -------- ­­­..... ..... ----- ----- ­....... ... <br /> -------- - ------ ------ --- -- ---- -------� ­­ ­-­------­-- - -------­­--------- -------------------------- ------------------ ------------------------- -------- <br /> -------------------------� ­--- ------ - ---- ------------ ­­--- ------- ------------- --­­---------- -------------- ------ ----- ------------------------------- ------ <br /> - ------------------- ---------------- ------ --------------- ------------------ ------- ------- ­--- ------------------ --------- <br /> ---- ------I- --------- ------ ---- - ---- - -- ------------ -I--- --- -- -------- ------------------- ----------- ------­------------------­ ----� -­------- <br /> -•--- ------- ------- <br /> FINAL INSPECTION <br /> ------- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> Stockton, California Lodi, California 132 Sycamore Street 814 North "C" Street <br /> Manteca, California Tracy, California <br /> ES-9-2M 0-52 Revised W-2100 <br />