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V <br /> APPLICATION FOR SANITATION PERMIT Permit No.�475i�.x <br /> (Complete in Duplicate) DEfe Issued <br /> A District for all the work herein descri d. <br /> Application is hereby made to the San Joaquin Local Health a permit to construct and i% <br /> stall <br /> application is made in compliance with Co nty.Ordinance No. 549. AAA-) —(f <br /> 1410ey s- "D -------- —----- <br /> JOB ADDRESS AND I -------e4-�- ------- -- _e- <br /> ------ ----- ------- --- ----- <br /> Owner's Name------ -------- - -- - ------- ------------------------------------------------- --------- 1141 <br /> Acldress_...___:� of <br /> - - ------- ---- -- ------------------------------------------------------------------ ------------------------------------------------ <br /> Contractor's Name.--__ ----------- ----- ----------------------------------------------------- <br /> Phone. <br /> Installation will serve: Resiclenc�e A r.ment House [] Commercial C] Trailer Court [I Motel ❑ Other 0 <br /> umber of bed ----------------------- <br /> Number of living units: rooms __/--- Number of baths __/--- Lot s <br /> Water Supply: Public system El Community system El Privateiv Depth to Water Table./0- ft. <br /> Character of soil to a depth of 3 fee+: Sand E] ' Gravel [] Sandy&arn Clay Loam [I Clay [] Adobe 0 Hardpan C] <br /> Previous Application Made: Yes D No� <br /> New Construction: Y <br /> TYPE OF INSTALLATION AND -SPECIFi XTIONS- <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I <br /> Septic Ta'n'k-. -Distance from nearest w Distance from founclafion__,/_4�------Mater a----r-- --- ---------- ____ _41�&. _ .9--------Capacity-----Fa <br /> Ile <br /> No. of compartments___ -*/Aiquicl dept <br /> -.Distance to nearest lot 1ine___-1'F' <br /> 'Distance from nearest well--- .-.Distance from foundation--/ <br /> Disposal Field: ---- <br /> -----Length of each line--------- <br /> --------------- <br /> ��4 _!--------Width of trench-------,f -------------- <br /> Number of lines__.__:V <br /> Type of filter material - ------- -._____Depth of filter maferlal--7---Y-,----------Total length---------- - - --------------------I <br /> t line_______.____--10 f <br /> Seepage Pit: Distance to nearest well________________ Distance from foundation-------------_----Distance to near - <br /> El Number of pits----------------------Lining material-------- -----Size: Diameter-•----------- - -------Depth-.------------------------------I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Linirig malerial--.---------------- ------------ <br /> pp <br /> h <br /> El ------ ch <br /> Privy: Distance from nearest well---------=---------------------------------------Distance from nearest building.:_­----------------------------- <br /> ElDistance to nearest lot line_';------------ -------------------------------------------------------------------------------•----------------------------------- <br /> Remodeling and/or repairing [describe}--------------- ------ ---------------------------------------------------- ---------------------------------------------------- <br /> e: ---------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------- r-------------- <br /> -------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------ ---------------------------------------------------I---------------------------------------------------------- ------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin Count <br /> ordinances, State s, and rules d regulations of the San Joaquin Local Health District. 14 <br /> or Contractotill <br /> (Signed)_ ---- - ----------------------------------------------------------- (Owner an <br /> ----------------------------------------------------------------------(Tifle) _ ....... <br /> By:----------------- ------ Pw <br /> e' plt`e4 on reverse side), <br /> (Plot plan, showing of lot, locAion of system in relation to wells, buildings, etc.. can b <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------- DA--------- ----- ----- TE--e <br /> REVIEWEDBY------------------------------- --------------------------------------------------------------------------------------------- DATE---------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------- ------ DATE------------------ --------------------------------I-------- <br /> Alterationsand/or recommend a+ions:-------------------------------------------------- ----------------------------------------------------------------------------------------------------------- <br /> ----------------------------------- -------------------------------------- ---------------------------- ----------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------I------------------------------------I--------------------:----------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------- ---------- -------------------------------------------------------------------- --------------------------------- <br /> ------------------ ------------------- ------------------- ----------------_---------- ---------------------------------------------------------------------------------------------------------------------------- -------- <br /> ------------------ <br /> -FINAL INSPECTION BY------------- -- --------------- ---------- Date---------- ---- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 110 South American Vreof 300 West Oak Street 132 Sycamore Street 814 North "C" Sfroef <br /> Stockton, California Lodi, California Manteca, California -Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />