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_ <br /> Permit No. <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> c� Date Issued <br /> Applicat' in is hereby made,to the San Joaquin Local Health District for a permit to construct and insfa,4 the work herein described. <br /> This a ication is made in compliance with County Ordinance No. 549. <br /> �� '---_--------- <br /> JOB ADDRESS A OCATION_______�I -- ------------1-----�'- ---•-- <br /> i ----- ----.. Phone__--� --------------- <br /> Owner s Name-------- ------•------- Q,� <br /> Address.-----------•-- -----•----- -- ----------- ----------------------------•----- <br /> Contractor's, Name- t <br /> f : Phone <br /> ---- -- ------- --- - ------ <br /> Installation will serve: Resl ence XM Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedroorris .1_._ Number of baths _,__-_�Lot size - ��_____} __ �+� <br /> Water Supply: Public-system'❑"Community system ❑ Private X Depth to Wafdr Table#& ft.'` <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, ' Hardpan ❑ { <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No # <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: F <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k <br /> _ d <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_____________-_.______..._._--_-_._____.________- <br /> ❑ No. of compartments_ ---- -----Size--------------------------------Liquid depth--------------------------Capacity---------------------- ` l <br /> Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line___________-_____ <br /> El Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------ ---------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length-------.---------------------------------- <br /> Seepage <br /> __________._ -________________._Seepage Pit: Distance to nearest well_,_/010________Distance from foundation__!____...___.Distance to nearest lot line <br /> Number of pits._..:-------Lining matefial /1i� __Size: Diameter__41 .____-------Depth___.A,i;-___________________ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__. _____________.Lining material______.____________.________._ <br /> ❑ Size: Diameter--------------------------------------Depth------- --------------------------------------------Liquid Capacity------------•------• - -----gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------------- <br /> . <br /> Distanceto nearest lot line--- --------------- ----------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe) - - - = + <br /> 1 — � Of <br /> ----- <br /> ------ - --01-- <br /> t5o ------------- --- -- <br /> ----------------------------------------------------------------------------•--------------------------------------------------- r <br /> I hereby certify thatLh ve prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, ared les and,regul Ions of the San Joaquin Local Health District. <br /> (Signed)_--------------------_----- -- _ -------------- --- ------- 1 [Owner Od/or Contractor) <br /> By:----------•-------------- ---------- pells, <br /> (Plot plan, showing size of lot, location of system in relation to buildings, etc., can be plac d on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----=-------------I---------------------------------V ----------------------------- DATE------------- <br /> REVIEWEDBY------------------------------------ ------------------------------------------------------------------•----------=---------- DATE-------------------- ----------------------•------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------- ------------ DATE----------------------------------------------------------- f <br /> Alterationsand/or recommendations:----------- --------------------------------------------------------------------------------------------------------------.--------------------------------- <br /> - <br /> l <br /> -------------•----------I---------------------------- ---------- <br /> ----------­------------ ------•--------------------------------------------------------------- <br /> - <br /> ---- <br /> FINALINSPECTION BY----- Date----- - ---------------------------- •-----------------��------- - ---------------------------- <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 10-52 Revised W-2140 <br />