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APPLICATION FOR SANITATION PERMIT Permit No, <br /> (Complete in Duplicate) Date Issued <br /> h <br /> Applica4-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 ip compliance with County Orc(inance ?o. 549. <br /> JOB ADDRESS A LO ATION <br /> ------------- ----- --- -- w z-6-@ ------------- ------------------------------------- <br /> Owner's Name---- - -- - -- -------------------------•----h-------------- ---------------------------­---------------- Phone------------------------------------ <br /> Address ......e.-Z- - --------------- ----- -----------I......I------------------------------------------------------------------------------------------------------------------------ ------------- <br /> Contractor's Name---- -- -- ---- - -------------------------------------------- I ------ Phone------------------------ <br /> -- -------------------- ---------- <br /> Installation will serve: Residence glApartment House I-] Commercial F] Trailer Court [j Motel E3 Other/[j <br /> Number of living units: Number of bedrooms -1- Number of baths ---I--- Lot size ------------------------ <br /> Water Supply: Public system Community-system El' Private [-] Depth to Water Table -------- ft. <br /> Character of soil to a depthsiof 3 feet: Sand Ll Gravel E] Sandy Loam Clay Loam Ej Clay E] Adobe�ardpan L] <br /> Previous Application Made :Yes E] No New Constructi6n: Yes Loam <br /> [3 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Mater <br /> Se t' Tank: Distancefrom nearest well-----------------Distances from foundation--- --------- -------— <br /> plepth ..... <br /> No. of c'o' mparfments........... ...... ---Size-,— 5f ----Liquid ---- ------------Capac;fy-_X <br /> pw -- --------f----- <br /> Field- D ---------- <br /> Di5 istance�.from nearest wO -D'sfa Distance from founclafion-49,__/,�-iistance to nearest lot Ii <br /> L r f---- <br /> Number of lines__________ - -------- _-L Length of each line----- Width of trench-____-- <br /> P21, r h - __ , " ----------yo-0_9---- -------------- <br /> Le <br /> .... ....Apt-r—Depth of filter material---------/F--------__-Total length--_._______ ----- --------------- <br /> Type of filter materia <br /> Seepage Pit: Distance',to nearest well----------------------Distance from foundation------------------_Distance to nearest lot line_____.___________ <br /> ❑ <br /> ine----------------- <br /> El Number'6f pits----------------------Lining material--- ------ Size: Diameter--------------_--------Depth-----------------•------------- <br /> Cesspool: Distance"from nearest well_________________Distance from fo-unclaflon--- -- ---- ---------Lining material-_--_._____________.____.____-_-_-_._ <br /> Size: Diameter--------------------- ------ -Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> IPrivy: Disfance4rom nearest well----------------------------------__---------Distance from nearest building_.__.______________________.._________- 4 <br /> } ❑ Distanceto <br /> uilding------------------------------------------ <br /> Distancejo nearest lot line---------- ------ - --------------------------------------------------- -------------------------------------------------------------- ------ <br /> Remod 111ng and/of re airing' (describe)______________ ----------------------------------------------------------------------------------*------------------------------------ <br /> ------------ ......I_-------------------•___............. _---------------------- <br /> ----------------------------------------------------------------------------------I------------ -------- <br /> --------------- ------- -------------------------------------------- <br /> _._.fi ------ ---- ---------------------- <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, ar)d.,!ules and regulations of the San Joaquin Local Health District. <br /> (Signed)-,........ <br /> 'e, ---------------------------------------------------------------- -----------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------------------------------------------------------------(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 BY_ ------------------ -- ---------j--------------- --------------------------------------------- D AT E_ --------- <br /> _.— ---------------------------------------- - <br /> --- <br /> REVIEWEDBY------------------------------ ------------- ----- ------- ---- ------- ------------------------------------------ DATE-- ---------------------------------------------------- <br /> BUILDINGPERMIT ISSUED. -------------------------------------------------------------------- •---------•- ------------------ .DATE-- --- ---------------------------------------------- <br /> Alterations and/or recommendations:._.---- --- -------------------------------------------------------------------------------------6-----------------------•--------------------------- <br /> -----------I------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- -------------------------- <br /> -------------------------------------------------------------­- ----- ---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------ -------- -- ------------- ----------- ------- ----------------------------- -------- ----------------------- <br /> -------------------------------------------------------- -r:------ -------------------------------------------------------------------- <br /> FINALINSPECTION BY:------------------------------------------------------------------ Date-- ---------------------------------------------------------------------------- <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 /> Er-9-2m 145446 A7W06D 12-54 <br />