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APPLICATION FOR SANITATION PERMIT Permit No. ../--. __ <br /> (Complete in Duplicated X/U'9 / <br /> Date issued _ L_. <br /> Applicaa-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 N"49. <br /> JOB ADDRESS AND LOCATION ... / { ------ c ��J�J <br /> = -------------------------------------------------=-------------------- <br /> Owner's Name._ `._..--- --------- --------------- ------------------------------------------. Phone------------------------------------ <br /> ­-x---;-= - - --------- ------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------- <br /> Contractor's Name---- - ----- --------�� e*0014:';4 I 1 <br /> Installation will serve: Residenceartment House.❑ Commercial ❑ Trailer-Court ❑ Motel ❑ Other {] <br /> Number of living units: I--- Number of bedrooms _Umber of baths .1___ Lot size _15-0------j(---/___ZJ7'----------____________ <br /> Water Supply: Public system &—cammunity system ❑ Private ❑ Depth to Water Table to ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 6�rpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [S—� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 10 <br /> (No septic tank or cesspool perrinitted if public sewer is available within 200 feet.) <br /> Set 3 Distance from nearest well__ ______________Distance from foundation--------------------Material _____.__.__.______.____..________.____._.___._.. <br /> No. of compartments- --- ----- -- ---- Size--------------------------------Liquid depth--------------------------Capacity------ --- ------ w <br /> ispos i Field: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line----------.-____. <br /> Number of lines-----------------------------------Length of each line---------------------------.-_.Width of trench._________.______..__________.___ <br /> Type of filter material--------------------- • p ! g � -- I <br /> Depth of filter material_______________________Total length <br /> Seepage Pit: Distance to nearest well_. ___Distanc roe foundation----- Distance to nearest lot line._.___,_ <br /> Number of pits__._...�-----------Lining.mate ria l-P�i -----Size: Diameter_ ___�_._______Depth___�,4�__�._ <br /> --------------- , <br /> Cesspool Distance from nearest we]-----------------Distance from foundation-----.--------------Lining material------------------------------------- <br /> ❑ Size: €diameter--------------------------------------Depth-- ------------ - ---------------- -----------------Liquid Capacity- --------------------------gals. r <br /> Privy: Distance from nearest well------------------_--------_-------_------___----Distance from nearest building_____...____:._____.__...___.___.______` k <br /> ❑ Distance to nearest-lot line----------------------------------------------------------------------- -------------------- <br /> Remodeling and/or repairing (describe)--------- --------------------------------------------------------------------------•---------------•------------------- <br /> -------------- <br /> -----------------------------•--------------------------------------------------------------------------------------------------------------------------------------- ------------•--------•••----•--------------------- <br /> --------------------------------------­--•----------------------•-----••-----------••--------------------------------..__.............-•--.-...._..-------••----------•---------------------•----------•--------------------- <br /> ---------------------------------------------- ---------------­------------------------------------------•-------------------------------------------------------------------••-- <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S la s, and r es and regulations of the San Joaquin Local Health District. <br /> {Signed)---- - -------- , -- -- ----- - - -- {�fo*'Contractor) <br /> liy:. ti's�T ----------------------------------------------- -----{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 <br /> APPLICATION ACCEPTED $Y ••-------------------- DATE�---•------------------- - <br /> REVIEWED BY------ ---------------------- - ------- ------------------------------------- DATE__ .. <br /> - -- --- -------------------------------- <br /> BUILDING PERMIT ISSUED------- ----,--•--------- ------ DATE.--�------ <br /> Alterations and/or recommendations:---------- ------------•- _ --"------------------------•----------------------• 11 <br /> ------------ r —� ----- -------------------------------------------------------------•---•--------------------.-- <br /> ..T- --------------------- ----------------------- ------------­---- ------------- <br /> FINAL INSPECTION BY:------ ------------------------- Date----- . S---•---- ------ -,>._ '_----------- ----------------•---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-2M 145446 PT-0 12-sa <br />