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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in-Duplicate) <br /> Date Issued ---- <br /> I-S-7 3y <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 compliant with County Ordinance No. 549. <br /> J ��B ADDRESS D L CQATION- - - -=---- --- <br /> --------------------}}---------- --------- ---------------------------------------- ----4 <br /> �ny <br /> Owner's Name------- ---------- - - -- ---- ----- - -----------------------------�1------------------ ------------------------------ ---- Phone----- �-�-----1-Z--------- <br /> -------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name-- --------------------------- Phone------------------------------- -- <br /> 1 Installation will serve: esi rice Apartment House ❑ Commercial ❑ Trailer Court ❑ Motgl ❑!! Other ❑ <br /> dNumber of living units: i/�umber of bedrooms _2-- Number of baths __Z__ Lot size __ -(__f!__i --------------------------- <br /> �� ommter Supply: Public system <br /> unity system ElPrivate E] Depth to Water Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe HardP <br /> an <br /> Previous Application Made: Yes ❑ No [.-New Construction: Yes M No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted ' publics r is availa6le within 200 feet. t <br />] Septic flank: Distance from nearest well__ _� sta e6rom oun tion____ ---------- ------------------ -- ---- <br /> F [ of compartments______ ___ _ __________Size_�C.l.___ �`_ _Liquid de lth____ ±'________________-Capacity---I --- <br /> No.Di-pos Field: Distance from nearest well Distance from foundatioan_-_ -(-_ _ •____L)istance to nearest lot ine_-� <br /> i <br /> --- <br /> Number of lines__________ ____ Length of each lin -' � g Width of trench__--_-__ __ ,.-�_________ <br /> ►� C�C� <br /> Type of filter materi ___'_ _�f�- 8epth of filter materiaL_______�_C.?__-____Total length__________________________________________ <br /> Seepage Pit: Distance to nearest weli___________________-_Distance from foundation__________________.Distance to nearest lot line_________________ <br /> d ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth------------------------_-------- <br /> Gryq sspool: Distance from nearest well----------------- from foundation------------------- Lining material--------------------------------------- <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------------------------------- <br /> _Distance from nearest building Privy: Distance from nearest well --------------------------------------- g <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------------------- ----------------------------------------•--------- V. <br /> ,. Remodeling and/or repairing (describe)----------------------------------------------------------------------------•.......-.------------------------------------------------------------------ <br /> .....-1 ------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- <br /> III --- <br /> w <br /> ------------------- --------------------------------------------------------------- ----------------------------------------------------------------------- ------ �� <br /> I---------------------------------------------------------------------------------­­-------------------------------------------------------------------------------------------------------•--------------------------- -- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, tate lawA, and rules and egulations of the San Joaquin Local Health District. <br /> ( agned] F ! --- ------- (Owner and/or Contractor) <br /> $Y:------------------------------•-------------------- -----------------------------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (t lot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. <br /> �b <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -------------------------------------------------------- ---- <br /> REVIEWED BY----------------------------------- -- --- - - <br /> --------------------------------------- - --------- <br /> - ----------- -- --- SATE_ <br /> B�t ILDING PERMIT ISSUED--------------------------------------------------------------- '- <br /> ------------- --------------------- DATE---------- -= i <br /> Alterations and/or recommendations:___-______________ _ <br /> -- -------------- - <br /> fil ------------------------------------------------------ -------------- --------------- - <br /> I---------•-------------- -------------------- ---------------------------------- ------------•---------------- -----------------•------------------------------------------------•------- <br /> ilh --------------------------- --------------------------------- -------------------------------------------------------------------------------- <br /> ---------------------- ------------- ------------------------------ ----------- <br /> ;Z6� <br /> FINAL INSPECTION BY:--------- --- Date----------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 5-51 Revised W-2100 <br />