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APPLICATION FOR SANITATION PERMIT Permit No- <br /> (Complete in Duplicate) <br /> Date Issued6- -� <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 com fiance with County Ordinance No. 549. <br /> -7 l t /,_� _ r`a <br /> -- ------------ --------�--------------------JOB ADDRESS AND LOCATION---,���� __._�_T_�.���_�--�-------------- ----------------- ' <br /> Owner'sName I t FRSMe --•------------------------- <br /> - ---------- ------------ <br /> -------------------------------- <br /> --------------------------- <br /> Contractor's Name--------------------------------------------- <br /> ----------------------------------- Phone---------------------------------- <br /> Installation will serve: Res'sdence V Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_ _._ Number of bedrooms ___2_ Number of baths ._L___ Lot size __ _ ___A ---------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private R-*Septh to Water Table _116__ 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 [Er� New Construction: Yes ZNo ❑ 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ~^l <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)` n <br /> Septic T k: Distance from-nearest well ;��Q _Distance from ,foundation__C_ ___.Mat rial_ 4,4)A RF rk ---------------- <br /> ---- <br /> --_------ _. <br /> of compartments ---� _•-_- Size_�__x-------I S_� iquid depth J -------_ Capacity----------------------- <br /> No. <br /> ` <br /> 21* <br /> Disposal Field: Distance from nearest well__..7�Q_...._.Distance from founclation____ _0 ___ Distance to nearest lot line_ -_.______-_- <br /> Number of lines <br /> Length of each line--------- - i-�-------Width of trench____2_4_��----- ---- <br /> Type of filter mat Depth of filter material----1.1.1.______--__Total length------------ ______________ <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__________-------__________________. <br /> ❑ Size: Diameter------------------------------------Depth------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance fro �w rr V =-. ~- _ __:_-= Disfiarici `ram neare +uilMng----- ------------------------------- - - -- <br /> "w Distance-to nearest lot line-------------------------------------- '' -----------------=------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------------------- --------------------------------------------------------- -=•-------------------------------------------------- <br /> ---------------------------------------------------------------------•------------------------------------------- ------------------------ <br /> ------------------------------ <br /> ---------------------------------- ---•------------------------------------------------------------------------ <br /> - -t ------- <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. <br /> (Signed)_ =a(- ALif � -------------- -------------------------------------------------- (Owner and/or-Contractor) <br /> By:------------------------------------------------------- -------------------------------------------------------------------------(Title)-------------------------------------------------=-------------- <br /> (Plot plan, showing size of lot, lacatirfl of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY----------- ----- ---------------- - ---------------------------------- ----------------------- DATE------------------------------- --------- ----------- <br /> REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE-------------------------------------------------------- <br /> BUILDING <br /> --------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:----------------------- ------------------------------------------------------------------------------•--------------------------------- <br /> -----------------------•---------------------------------w:--------------------------------------------------------------------------- <br /> -----------I----------------------------------------------------- <br /> -----------------------•----------------------------------------------------- •---------------------------------------- <br /> ----------------------- ------------------------------------ ------------------------------------------------------ --------t-------------- - ---------- - <br /> FINAL INSPECTION B :. ------ ----------------------------------------------------- Date-----------L'----- ------ <br /> -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Streef 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 ��� <br />