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APPLICATION FOR SANITATION PERMIT Permit No <br /> (Complete in Duplicate) <br /> Date Issued -------- <br /> �A�plicafion is hereby made to the San Joaquin Local Health District for a permit to construct <br /> 's application is made in compliance with Count ordnance ance N 549. and install the work herein described. <br /> JOB ADDRES"NDj]_232�TION <br /> --- - - -- -------- ---- <br /> Owner's Name-1 �d"-.---------------------------------- <br /> ----------- --- - ---- -- --------- --------------------------------------------------------------- Phone- <br /> --------- ---- <br /> Address_.��_Lck)--- ---------- -- -- -------------- ------- -t ------------- <br /> Contractor's Name""_ ------ ------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------ Phone <br /> Installation will serve.: Residence Apartment House 0 Commercial El Trailer Court E] Motel D Other <br /> Number of living units: ----f N,umber of bedrooms Z__ Number of baths _ <br /> /_ Lot size <br /> Water Supply: Public system Community system E] Private E] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet. Sa <br /> nd Gravel n Sandy Loam " Clay Loam E] Clay El Adobe Hardpan El <br /> Previous Application Made: Yes [ No <br /> Construction: Yes ;?'No ❑ <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 Disfan from and lf tion <br /> _""1'_ <br /> -------- Mate <br /> -------size----- Uquid depth---of compartments---------- -------------------- <br /> �6-----------Capacity---- <br /> Dis Field: Distance from nearest weiI__-_—_--, Distance from foundation 1Z I -V-Distance to nearest 4� 6 <br /> V Number of lines----------- ---,,Length of each line--------- _ench­_—­'x4t- -------- <br /> -­-_Wic1th of1r <br /> Type of filter material-- ------ 7--------------- <br /> epfh of filter material-----------/V--,------Total length--------- ----- <br /> --------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------D stance to nearest lot line----------- <br /> El Number Of pits----------------------Lining malerial-----------------------Size: Diameter--_.""-"-_-_" Depth-------------------------------- <br /> Cesspool: Distance from nearest well---------------- Distance from foundation-_----_--------__.Lining <br /> . Size: Diameter -1ining material__-_"__------------------------------ <br /> r�6F�,���_St ---------------- -------Depth-------------------------------------- ----------.--Liquid.Capacity-----------------------------gals. <br /> Privy: Dist a�ce­ -W-11 <br /> T nearest e - ------------------------ ----- -_Distance_from sf.build�ng__ <br /> ---- ------- <br /> F1 Distance to nearest lot line---- ---------- n e a ce -------------------------- <br /> -- -- ----------------------------------------- ­t� <br /> - - -------------------- <br /> Remodeling -and/or rep6irirg (describe)-------------------------------------------- It <br /> ------------------------------I-------------------------------------- ------------I----------- ------------------------------------------------------------------------------------------------------------------------------ <br /> ---------w------------------------------------------------------------------------------------------------------I---------------------------------I------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------7-------------------------------------------------------------------------------------------------------------- <br /> I hereby certify fhaf I have prepared this application and that the workwillbe done in accordance with San Joaquin County <br /> - A <br /> ordinances, State laws, and rules an re regulap.4Dns of the 57 Joa,quin Local Health District. <br /> (Signedl.',� <br /> -----------------------------------------------------------------------(Owner and/or Contractor) <br /> By:__----------------------------- --------------------------------------------------------------------------------------------(Tif le)-----------------------------------------....................... <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 /> REVIEWED BY------------------------------- ------------- <br /> --------- <br /> ------------------------------------------------------------------------ DATE -------------------------------------- <br /> BUILDING PERMIT ISSUED <br /> Alterations and/or recommendations: ----------------------- <br /> TE <br /> ---------------------------- ---------- ---------------- <br /> v ---------------- <br /> 1�_44-------- <br /> if` • <br /> -_ ---- ------ <br /> -----------•---------------------------------- ----- <br /> ---------------------- <br /> I---------- <br /> ----------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ —---------------- <br /> - <br /> INAL INSPECTION BY:..,�_ 1s:.. ------------------------------------------- Date---------- <br /> ------------------------------- <br /> F0 SAN JOAQUIN LOCAL HEALTHDISTRICT <br /> 130 Scufh American Street 300 West Oak Street 132 S I yeamore Street 814Nor+h "C" Street <br /> Stockton, California Lodi. California Manteca, California Tracy, California <br /> ES-9-2M .8-51 Revised W-2100 <br />