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APPLICATION FOR SANITATION PERMIT Permit No. .S�.l-..-d..- _ <br /> [Complete in Duplicate] <br /> . � Date Issued _______________________ <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 No. 549. <br /> } �y <br /> -------------_-------_--------------------------------------------------------- <br /> JOB ADDRESS AND LOCATION.. _ ;. .c $ <br /> Owners Name - i Old Phone <br /> -------PAWV -- ----••------- --------------------- <br /> xAddress------------ -` -------------------------- -------------------------- <br /> ---------------- ----•----------------- <br /> ------- . --- <br /> Contractor's Name j�--------------------•------------------------------------------------ Phone---------------------- - <br /> Installation will serve: *Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ] Other ❑ <br /> §' �� �� <br /> Number of living units: --- ---- Number of bedrooms .--,�___ Number of baths -------- Lot size ________._______________________________-------.._.-___.___ <br /> t_.- <br /> Water Supply: Publicfsystem "'Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe J Hardpan C]Previous Application Made: Yes E] No El <br /> New Construction: Yes No I+ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank:or cesspool 1.permitted if public sewer is available within 200 feet.) rf <br /> Se tic Tank: Distance from nearest well-----0_�"_Distance from fou dation______ -_.___-.Material__________ _______IUO __-________._...____. <br /> p <br /> p ------SERE-----5-X.,11- '---� - Liquid depth--------YZ�----------Capacity---�S'd-�------ <br /> No. of tom artments_____.�:-_________ -- ------- <br /> Disposal Field: Dis ante from nearest well...:_ ------Distance from foundation_____) _��.___.Distance to nearest lot line __..... �{1 <br /> Number of.lines-----__.---1:...i----------------Length of each line------------- f --------.Width of trench-------,_-24------------------ <br /> Type of'filter material--_-_ ___Depth of filter material-------[t. ----------Total length---------J6C?-._.__................ <br /> Seepage Pit:- ' Distance oto nearest.well------------.---------Distance from foundation____•_..-_-._____.Distance to nearest lot line______________._. <br /> ❑ Number of pits----------------------Lining material-- _:-----Size: Diameter---------- -_---------Depth--------------------------------- <br /> . I - vvv <br /> Cesspool: Distance from n-earest well----------------_Distance from foundation------.---- ---------Lining material-------------------------------------- <br /> El - ' Size: Diameter------------------ --- ---------------Depth---------------- -----------------------------------Liquid Capacity-------------------------.--gals. <br /> Privy: Distance from nearest,well-------------------------------------------------Distance from nearest building____._._______________________.__._____._. <br /> ❑ Distance'to nearest lot line:__:__.'_-__'_._..' ` M i <br /> Remodeling and/oar repairing (describe):-------_.__.-------------- <br /> -------•-•--------•------------------------- -------------------------------------------------------------.---------------------------------------------------- ---------------------------------------------------- <br /> ------------------------------------------------------------------------------------------•------------------------------------------------------------------------------- •_....._.----...--------------------------------- <br /> I hereby certify 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. y - <br /> (Signed,-----. j `---------------------- -- ----- = ---- --- <br /> caner and/or Contractor) <br /> " <br /> By--------------------------------------------------------------------------------------------------------------------------------------(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 i <br /> APPLICATION ACCEPTED BY--------------------------- ----------------------- ----�------------------------- DATE--------------- � ��--`------- <br /> REVIEWEDBY------------------------- - � --�-- ------------------- DATE------------------------------- ------------------------- <br /> BUILDING <br /> --- -- <br /> BUILDINGPERMIT ISSUED----•-•----------------------------------------------------------------------------------------------- DATE------------------------- <br /> Alterations and/or.recommendations----------------------------------`------ -----._..----•------------- .............._..------- -------------------_--••_------•--------............... <br /> .. <br /> --------------------------------------- ------- ------------------------------- ---------------------­ <br /> { <br /> ----•--------------------------------------------------------------=------------------------------------------------------------------------•----------------------------------------------------------------------- -•-.. <br /> i <br /> FINAL INSPECTION <br /> ------- Date----------=- ------------------------ <br /> ------------- <br /> ---- -------------- <br /> SAN <br /> ---..----SAN <br /> 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 Ravised W-2100 ' <br />