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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued -- ----- <br /> Application 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 Or ante No. 549. <br /> ------- --------------- ------ -------- -- ----------- <br /> JOB ADDRESS AND LOCATIQV. 6 - "I ----*- ----- ------------------------------------------------------ <br /> Owner's - - -------------------------f I ----1qy6;_"s- ------ P h one._�ile _7m <br /> Address........ -------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name------<C&c A, <br /> _----- --------------------------------------- Phone_� <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court Ej Motel ❑ Other El <br /> L <br /> Number of living units: J---- Number of bedrooms Number of baths __/__ Lotsize ---1!.5n -------------- -------------- <br /> Water Supply: Public system ;< Community system El Private [] Depth to Wafer Table -------- ft. <br /> *Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay E] Adobe El Hardpan El <br /> Previous Application Made: Yes E] No [] New Construction: Yes El No [j <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> N '0 tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 0 r (f <br /> ep L4 <br /> ,c a nk: Distance from nearest well_________________Distance from founcla ion---/0--------Materia�------------------------------�Z�_ <br /> ❑ No.,of compartments-----------eo" __------Size-A/A )(_ ,/00�'10&ALiquid depth------0;111 Capacity---#---------------- <br /> 1. -----/ ---/--- <br /> D; al Field: Distance from nearest well-----------------Distance from foundation-_Z10 -- <br /> ------Distance to nearest lot line- <br /> Number of lines---------------___.. <br /> Le'n9th of each line--__-_. __Width of french -------------- <br /> T Q_CkDe'p <br /> Type ofilter material__--Sth of filter material---------------_j_--------Total length--------- ---------------------------- <br /> f - - ------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_.--.___--___- <br /> erial Diameter-----------------------Depth--------------------------------- <br /> El Number of pits----------------------Lining material-----------------------Size:Size <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------_--------Lining material----------------------------_.____.-. <br /> ❑ <br /> aterial-------------------------------------- <br /> El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity_-------------------------gals. <br /> F <br /> Privy: Distance from rearest well--------------------------------------------------Distance from nearest building--_--...--.-.-_-..-.--_----_.---------... <br /> 0 Distance to nearest lot-line--------- --------- --------------------------------------------------- ------ -------------------------------------------­­-­---------- <br /> Remodeling and/or repairing (describe):------r--------- ........ ---- 1-1 1------- <br /> ------------ <br /> ----------------------------1------------------------------------------11---------------------------------------------------- ----------------------------------------------------------------4-- ----------------------- -- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I---------------------------------s <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------------------- -- --- --------------------------------------------------- --- ------------------------------------------------------- ----10. )4ner and/oIr, Contractor) <br /> .--.9--- - ----- ---------- - ---------------------------------------{Title) <br /> . . .......... <br /> By:--------------------------- - -A.._P --- -_ --il <br /> (Plot plan, showing size of lot, location of system in relati n to wells, buildings, etc., can be placed on reverse side). <br /> FOR'DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. opo ------------- DATE------- ----------- <br /> ---------------------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------I----------------------------:----------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------7--------------------- ------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:--------- ---------------_------------ ........`------. ---------------------------------------------------- ----------------------------------------------- <br /> ---------------- ----------------------------­­­------------ <br /> -----------------------------------­­----------------------------------------------------------------------------------------------------------------- <br /> ----------I---------------------------------------------------------------------------------I----------------- -------------------------- ------------------------------------------------------- <br /> ------------------ -------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------•----•-------------- <br /> ------------------------------------- <br /> ----------I------------------- <br /> ------------------------------------- ------------ ----------------------- --------- ---------------­- ----------------- ------- -------------- --------------------------------------------------------------------- <br /> FINAL INSPECTION BY:.. -- Date---. -------------- ---------------------------------------------- <br /> -- ---------------- - ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />