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APPLICATION FOR SANITATION PERMIT Permit No. ..` -_ - --3__-_ <br /> (Complete in Duplicate) ��53 <br /> atessued/ - ------------- <br /> Applica+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 No. 549 <br /> JOB ADDRESS AN C TON --- �- Y = <br /> Owner's Na :-------- - - - -- ------ - -----------•--------------- --------------------------------:--- Phone, -t ---••------------ <br /> Address <br /> ------ ------- -- ------------------------------------------------------•-------------------------------------------------- <br /> Contractor's Name-------------------- ---- ------I-� -- -- ----------=-------------------------------------------- ------------------ Phone---., <br /> will serve: Residence J� Apart 'ent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _-�__ `Number of bedrooms �_- Number of baths ._/-- Lot size -- _/ _ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablet. ft. <br /> Character of soil to a depth of 3 feet: -Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobelk Hardpan ❑ <br /> Previous Application Made: Yes ❑ NOX New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:. '' 11 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank: Mstance�.from nearest well---------_-------Distance from foundation--------------------Material-_-_--_-----.-----.------..---_-__----_-_-----_. <br /> No. of compartments-------------------_.....Size----•---------------------------Liquid depth--------------------------Capacity------------------------- <br /> Disposal F• d: Distance from nearest well_________________.Distance from foundation--------------------Distance to nearest lot line-----_--------_- <br /> Number 'ofiines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material-------------------------Depth of filter material----------------------.Total length---------------------------------- <br /> Seepage it: Distance.to nearest well Distance fr rg f ndation-- _'_-.-.Distance to nearest lot line----Xt -e` <br /> Number of pits___- _.--.---.__Lining material- Size: Diameter_-,��____. _._..Depth_ �_ r �°� <br /> esspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------.__--._-_._--_--. <br /> ❑. Size: Dia'meter-------------------------------------Depth--------------------- ----------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well_________________L-------------------------------Distance .from nearest building------------------------------------------ <br /> �.. <br /> ❑ xi <br /> Distance`to nearest lot line--------------------------- J,91�- ------- <br /> �/ �i <br /> C <br /> Remodeli and or repairing rine :.._ _ <br /> - <br /> ------ ------------------------------ ----------•--=----------•------•---------------------•------------•----------------------•------- --------------•----------------------•---------------------------- --- <br /> I hereby certif at I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> o dinances, State I s, and e a nd regulati ns of the San Joaquin Local Health District. <br /> ----------------------=------=------------------ ----------"------------- - Owner and Contractor <br /> 3 (Signed)------------ - -------- ( ) <br /> B ---- :. ----------------------------------- ------------------------------------------(Title)- ----------- <br /> (Plot plan, showing size of to , locatio of system in relation to wells, buildings, etc., can be pl on rever side <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By DATEf <br /> --------------------------------------------------- <br /> REVIEWED BY---------- ---- --- ----------------------------------------------------------•-------------------- DATE ------•------------------------------------------------------------------ <br /> - <br /> BUILDIN <br /> ------------- <br /> BUILDING PERMIT ISSUED---- J ___­---------------------- --------------------------------------------------- DATE - W--"- <br /> Alterationsand/or recommendations:--------------------------------------------- - ------------•----------------------------------------------------------------------------•--------------------- <br /> --------------------------------------------------------•----------------- ----------------------------------------------------------------------------------------------------------------•---- ------------------------- <br /> ----------------------------------=-----•-------------=-------------------- ----------------------------------'----- ------------------------------------------------ <br /> --------------- ---------------•------------------------------------------------ ------------------- ---------------•-----------------------­­---------------------------------------- -------------------------------- <br /> -------------------------- - --------7---------------------- ------- - -------- ----•---------- ---------------- ------------------ ----•-------------------------- --------------------------------=----•-------- <br /> M <br /> FINAL INSPECTION BY-_L- - Date_.. _ .f. `.aj <br /> --- ---------------- -- ---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M ; Revised W-2100 s4 <br />