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APPLICATION FOR SANITATION PERMIT Permit No. <br /> *' �q <br /> _._.•_____..-._. <br /> 1 (Complete in Duplicate) Date issued ----- <br /> eA plication 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&LATION =-A-7/1------- ---------------=------------ - l ye---- <br /> ------------- -------------- --------------------Owner's Name- - ---- =-• --------- -----_ •------Address . ----- -- ----------------- -----• ----- <br /> Contractor's Name------------------------------ - -- -- -- --- ---- Phone -.. <br /> a � ; <br /> Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -__ Nurti�ber of bedrooms -C Number of baths ---Z Lot size _-'' Q ------------------ <br /> Water Supply: Public system �ommunity system [I Private E] Depth to Water Table 3/0 ft. <br /> Character of soil to a depth'of 3 feet:4 Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑_— I <br /> Previous Application Made: -Yes ❑ No [9----New Construction: Yes ❑ No 2�FHA/VA: Yes ❑ No [i}— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> tlp ' ank: Distance'from nearest well------------------ from foundation---=---------=._-_-.Material------.------_..------.------_-.-__-__.----_---. <br /> Capacity <br /> No. of compartments------------------------ Size--------------------------------Liquid depth-------------------------- ------------------------ <br /> Disposal <br /> ----- -- -• - ----bisposal field: Distance from nearest weilistance from foundati _---,� ---------Distance to nearest lot line- ._ -• <br /> Number of lines-------- Length of each line----- ---4Ar Width of trench-- _y-----------�__--_- <br /> Type of filter material--6 _,__.___ - Depth of filter material--_.---�k----Total length----------------------?Z----_-.--.- <br /> e�p Distance.to nearest welt-------- ---------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: <br /> -----_-------- _--------_.---.Sixe: Diameter-------- Depth '----------•--------------------------- ---Ligui.d,Capacity----------------------------gals. <br /> " l_________________________________________________Distance from nearest building------------------------------ <br /> ----------- <br /> Privy: Distance from neo est weE❑ Distance to nearest lot line-----I--------------------- = <br /> F <br /> Remodeling and/or repairing (describe):------------- <br /> ----------- ------ ........--------------------------------------------------------•--------- ---------------•------------------------------------------•-----------------._.-..--------------------- ------------- <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, Staws, and rules nd re tions of the San Joaquin Local Health District. <br /> ��------- t----..'--------- --- e Owner and or Contractor , <br /> (Signed) { / ) <br /> ---------- - - <br /> By=-------------------------------------------- --/{---------- -- ----�1- [Title)----E-477-1------------------------------------- <br /> (Plot plan, showing size of lot, location'of system in relation to wells, builds s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------- ------ DATE---- <br /> REVIEWEDBY------------- '•---------------- _ - ------- ---------------------------------------------- DATE----- � I •--------•-- .c <br /> BUILDINGPERMIT ISSUED............. ------------------------ ------- ----------------=---s-------------------------------- DATE-------------------------- <br /> Alterations and/or recommendations---------=----------------------------------------- ------------ --•--•---•---• -,-----••----------------------•--------------------------------- <br /> ----------------------------:------------------------------------------------------------- <br /> ----•--•---------------------------------------------------------•------------------------------ --------------------------------------------------•-------------------------------------------------------------.1-------------- <br /> --------------------------------------------------- ------•---------- --------------- ------------------------------- - ., . -- --------- <br /> FINAL INSPECTION BY::.-/" ,.'- Date . ` "-- <br /> SAN JOAQUIN LOCAs. 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 1-57 F,P,CO. 7 <br />