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APPLICATION FOR SANITATION PERMIT Permit No. <br /> u (Complete in Duplicate) Date Issued <br /> 1 - / <br /> Applica ion 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 Ordinance 549. <br /> JOB ADDRESS AND A N- ---------- ------------------------------•----------------------- <br /> ---- - <br /> ----------------------- - -------- Phone---_-----•--------------------•--- <br /> Owner's Name ----- - - --------------- <br /> Address----------- <br /> --------------Address----------- •oc- --- -- - -------- ------------------------------ <br /> -_•- -/---------. --•------- <br /> Contractor's Name-------------------------------------------- --- ��!'YC, ----- <br /> -------------------------------------- Phone- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> �, �, ..r . <br /> Jr <br /> Number of living units: _ Number of bedrooms ._ Number of baths __/ Lot size _____S __ <br /> Water Supply: Public system Q�Community system ❑ Private ❑ Depth to Water Tablex/ <br /> Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay°Loam ❑ Clay ❑ Adobe 2?--N-ardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: . <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 fet.) i111 <br /> pti Tank: Distance from nearest well_________________Distance from foundati��quil_________.__.Material__ __.______._______________,____- --_____. <br /> tmenfs <br /> sa Meld: Dotaonce fromrnea est-well_________________D'stance from foundation-----depth____._--_____-___-_______Capa�ity__.--------------____-. .; <br /> po _____________Distance to nearest,lot line-.--------------- <br /> Number of iines-----------------------------------Length of each line--- --- _-_-_-._.Width_ofarench__ -=------•---------------____-- <br /> Type of filter material------------- _ Depth of filter material-----------------------Total length------------.-------.__-__________________ <br /> c� � i <br /> Seepage Pit: Distance to nearest well. U Distan e 4____ <br /> u � Distan to nearest lot line_____ ____-. <br /> Number of pits.__________________Lining material-_ _ __.Size: Diameter----3�_..._______-Depth----G�� __-- ------ t4 <br /> Cesspool: Diis,tanee from nearest foundation_•-^"{-----------Lining material______________________________________ <br /> ❑ Size: Diameter-------- ---------------,-----------Depth-------------------------------- ------- ----------Liquid Capacity-------------- ------------gals. <br /> Privy: Disfance from <br /> nearest l ---- Distance from <br /> mnearest building------------------------------------------ <br /> ❑ Distae to nearest Ilot Ine ------------------------------------------- <br /> -------------- --- -------- -------------------------gy----------=------------ ------------------------------------------------- <br /> /or <br /> Remodeling and' repairing (describe):---------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> _________________________________________ ------------------------i:_.-___•-___________-________--__._-___---_--_.---------------------------------------------.______..___ <br /> I i <br /> ! hereby cer+if a I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, tat awsjeind rules and regludiations of the San Joaquin Local Health Distric+. <br /> ` a <br /> (Signed) caner and/or Contractor) <br /> :�. ,. <br /> BY• (Ti+le) – ------------------------------- <br /> (Plot plan, showin6iize f lot, location of system?in relation to wells, buil ngs, etc., can be placed on reverse side). <br /> {� r= FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ul^^­------------------------------------------ - - --- DATE------ ! f <br /> REVIEWED BY -------------------------- ---._. DATE- ------ <br /> BUILDING PERMIT ISSUED------•---------------- - --------------------------------------------- DATE----- ---------------- ------------- ------------------ <br /> -- -------------------------- <br /> Alterations and/or recom�endations:-----------------------------------------------------------•-------------------1-------------------------------------------'-------------------------- <br /> ------------------------------------ ------------------------------- <br /> t _ f <br /> _____________._______.________.------------------- ___ ---------------------- ___ ____ __________J <br /> ___----------------------------------_------------------------------------------------- <br /> ------------------__.__ <br /> FINAL INSPECTIO ..r ---- ----- ----- ----------- --- ---- Date------7_77-&-51 <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 Revised 1-57 F.P.CO. <br /> - r <br />