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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) Date Issued <br /> (VIA <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549.,/'l <br /> JOB ADDRESS AjDaOCATION---------ql.- -------------­---......­............................................. <br /> Owner's Name------ - --------- ------- ------- -- -------------------------------------------------------- Phone-c:P-—-------A_ <br /> Address............... ...... ..... - -- - ---------------------------_-_-......................................................------------------------------------------ <br /> Contractor's Name---- ---- - ---- - -- ------------------------------------------------------------------------------------------------------------ Phone..... <br /> Installation will serve: Residence [] Apartment House [] Commercial E] Trailer Court [] Motel 0 Other <br /> Number of living units: -------- Number of bedrooms -------- Num baths -------- Lot size --------------------------------------------•-_-.........I <br /> Water Supply: Public system [I Community system F1 Private Number <br /> to Water Table -----_ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam [] ClayLoam 0 Clay C] Adobe 0 Hardpan ❑ <br /> Previous Application Made: Yes 0 No [-] New Construction: Yes El No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.................Distance from foundation.....................Material.__ .._.__.__._... <br /> --------------- <br /> Size--------------------------------Liquid depth--------------------------Capacity__------------j <br /> 171 No. of compartments.............. <br /> Distance to neares 104tr t_cs ....... <br /> Dispos9k Field: Distance from nearest6---.Distance from foundation.......9-------- <br /> Number of lines.___-------0.... ,Length of each line........ *576�2 t Width of trench___ .............. <br /> Type of filter mat i...........4064epth of filter material.........L-57,*Total length............ <br /> Seepage Pit: Distance to nearest well-__ _-_---_:_-___•__Distance from foundation....................Distance to nearesf'loi-line................. <br /> F1 Number of pits_____ _______ ___Lin2*!,,p m f i I ------------------Size- Diameter -----­---------Depth <br /> , , ya eria----- r----- -------- <br /> Distance from neva �2,'_Distance from fturidation.- <br /> CeJ� - <br /> t we ...LO.......Lining material...- <br /> Size: Diameter........11 <br /> ----------Dept h................W---------------------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building....-_._ _.._.......................... <br /> Distanceto nearest lot line---------------------------------------------- -------------------------------------------------------------------------------------------- <br /> ---------- -------------- <br /> Re od&g ancler,�riri.wtlscribe .... .............. ... ---- ---- -------- <br /> ....# .... ....... .... <br /> ............, <br /> _ _6 <br /> . .. .......#........ <br /> ... ................................. ............... ................... ............. ..................... .................. <br /> ------ ....................................................................................................-------------­-_-­--------­-­--- ------------------------------—--7-------------------------------- <br /> -----------_- ......................................--------------------------------------------- ----- ----­----------------------------------------------------------- <br /> I hereby 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 regulations of the San Joaquin Local Health District. <br /> (Signed) -------------------------.....................------------ ...........(Owner and/or Contractor) <br /> By:--------------7- ...............................................................................................--------_---(Title)------- ----- ------------------------------------------ <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_.Q5.;<,............................................... <br /> REVIEWEDBY. ----•---• - ----------­--------------------------------------------------------------- DATE. ........................................ <br /> BUILDING PERMIT ISSUED..................................................................................------------_.... DATE..............46- <br /> 4...................................... <br /> Alterations and/or recommendations:,.._._.....-. -----------------------------------------------------------------------------_-------------------.......... <br /> ........................................................................................................................................................................................................................ <br /> ...........................................................................................................................................................................................----------I............ <br /> ............................................................................................ ...................................................................................................I....................... <br /> ................................................I................. .. -----------------------------------*-----------------------------------------------------------------------*--------------------------------------- <br /> FINAL INSPECTION BY:............ —--------------------------- Date---- ......... <br /> .................. <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 -"fracy. California <br /> E5-9-2M 8-51 Revised W-2100 <br />