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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) / <br /> Date Issued .__X <br /> ___ A— <br /> A <br /> — <br /> I <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 complianceiwith County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION---/.,3—'�s� — <br /> Owner's Name--------------------------------- ---------------------------------------•------------------ Phone-- <br /> Address----------------------------------------------- S_.--01:0.-?"Le----------------------------------------------------•------------------•-•-•---------------------=-------------------------------- <br /> Contractor's Name---------------------------e�Aq'-- - " "� ° "� + °'"------------ Phone__9!�75F 7--.------- <br /> Installation will'serve: ResidenceA Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .----- Number of bedrooms k__ Number of baths --1-- Lot size '- <br /> ---------------------------- <br /> Water Supply: Public 'system ❑ Community system ❑ Private K Depth to Water Table 449 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑. Sandy Loam ❑ Clay Loam ❑ Clay ❑ A obeI% Hardpan [❑ <br /> Previous Application Made: Yes X. No ❑ New Construction: Yes ElNo ❑ / C <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> eptic qnk: Distance from nearest well-----------------Distance from foundation-----------.--------Material----------------------------------------------- <br /> No. of compartments--------•-----------------Size-------------------------------.Liquid depth--------------------------Capacity-------•-------------- <br /> Disposal Field: Distance from nearest well-A/D. from foundation--� ----_-_--Distance to nearest lot line..._._.. <br /> Number-of lines------- ------ ------------Length of each line----60'_--------------.Width of trench--_-_d/ _----------------- <br /> Type of filter material---- -----Depth of filter material-���----------Total --- ­---- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_-----_---------- <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--_---------------------------- <br /> Cesspool: Distance from nearest well---_-_----------Distance from foundation--------------------Lining material----------------.---_-_-__----------. Wr <br /> ❑ Size: Diameter_ =----------------------------- Depth Liquid Capacity. -.- gals. T <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building--------------------------------------- <br /> F1 <br /> ---_---.--__-_-__-.--._-_-__._-__--..❑ Distance to nearest lot line----------------------------------- <br /> Remodeling and/or repairing (describe)------------------------------------------- -------•------------------......._. ----------•---- ............... <br /> -------•-----•---------------------------------------------------------=----•--------------------------------•------------------------------------------•-------------------------------------------------------------------- C, <br /> ­---­----------------------------------------------------------- ----------------- ----------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------•--------•----------'•-----------------------------•--•-----------'-------------------------------------------------------•--------------------- <br /> I hereby certify that I hay. prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws and�ule and' regula+ion�ofn�Joaquin Lo al Health District. <br /> a <br /> {Signed - ' (� Contractor) <br /> I------------------ <br /> 13� <br /> t <br /> BY� - -------- ----- ------------------------------------(Title)---- H'r1c*----------------------- <br /> (Plot plan, s Ing size, of lot, location system in relation to wells, buildings, a+c., can be placed on reverse side). j <br /> FOR DEPARTMENT USE ONLY <br /> T <br /> APPLICATION ACCEPTED BY-V-- --- ------------------------------- ---------------------------------------- DATE--�----- <br /> REVIEWEDBY--------------- I------------------------------------------------------------------------------ DATE <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------- ------------ <br /> Alterationsand/or recommendations------------------------------------------------ --------------------------------------------------------------•----•------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------- <br /> FINAL INSPECTION BY:------- ------`--------------------------- Date__/--- .-- -- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> 4 - <br /> E5--9-2M 8-51 Revised W-2100 <br />