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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <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 compliance with County 0i'dinance No. 549, <br /> JOB ADDRESS LOCATION___4 <br /> ----- ------- <br /> - --------------- <br /> + 0-e ----------------- -- -----------------------------------------••----------- <br /> Owner's Name- ---------- - ---- ­--------- ------- --------------- Phone-Z <br /> ---- - -------- - -------- <br /> Address-------- -- - <br /> Contractor's Name__. ---------- ? --------------- <br /> ---------------- Phone J?_ <br /> Ins.tallation will serve: Residence Apartment House E] Commercial E] Trailer Court [] Motel [I Othej. E] <br /> f. Number of units:living <br /> g units: -------- Number of bedrooms _Z__ Numb lbaths J---- Lot size ----7_P_!-YI <br /> Water Supply: Public system El Community system El Private Number <br /> to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sa <br /> nd Gravel 0 Sandy Loam. Clay Loam 0 Clay Ej Adobe [Hardpan E] <br /> Previous Application Made: Yes E] ,�i No Construction: YesOPNO El <br /> TYPE'OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank, Distance from nearest well_________________Distance from foundation________________- Material <br /> ---------------------- <br /> ❑ <br /> No. of compartments-------------------- -Size----.---------------------------Liquid dep -------------Capacity---------- <br /> h ------------- 4- - <br /> DisposalF nearest well-C.5 <br /> 0 ------- <br /> iol Distance from ' - --- -Distance from foundation r—Distance to nearest ]of)ine-- <br /> Ellines___________ <br /> Number of lines----------- ------- ---Length of each line--------- <br /> _*----- Width of trent _ <br /> Type of filter material - --------Depth of filter material---------- ----------Total length-4. ,_n----------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation_-_-______________- Distance to nearest line__-_--_____-_-__ <br /> ❑ Number of pits__-�------------------Lining material-----------------------S;ze: D arnefer-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------- -----__-.Lining material-_________________________❑ <br /> Diameter------------------- ------------------Dept ------------'----Liquid CaPacifY------------------------ <br /> Privy: Distance from nearest well________________ --------- -- ------- <br /> ----__Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line_______._- ____ <br /> Remodeling <br /> ine---------- <br /> Remodeling ncdt/o t repairing ( t <br /> --------------------------- <br /> ---------------- ------ --------------- -,-L-------------------------------- <br /> ----- - ----------------- ---- --- <br /> ---------------------------------------------------------------------------------------------------------------- ---------------- �j-------- <br /> ------------ <br /> ------------ ------- ----------------------------------------------------- <br /> --------------------------------------------------------------1-------------- ---------------------------------------------------------------------------------------------------------------------------------------------- <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, Stafe laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)- ---- <br /> A e �r -----------------------------(Owner and/or Contractor) <br /> - -- ------------ <br /> By:_--------------------------- <br /> ---------•----- <br /> ---------*------4--------------------------------------------------------------------------------------(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-- <br /> "t-—---------------------------------------------------------------------- DATE-- - ----------------------------------------- <br /> -- ------------------------------------------------------------------------- DATE--------- <br /> -- <br /> REVIEWED BY �jZ%, <br /> BUILDING PERMIT ISSUED---------- ------------------------------------- <br /> - ------ ---- ------ ---------------I-------?------------------ - DATE-- <br /> f- ft <br /> r_1 <br /> ------ - -------- <br /> - <br /> - <br /> --- ---------- ---------- ------ <br /> ---------------------- ------- <br /> Alterations and/or recommendations:__-. 43,_,�r_,__ <br /> ajJ_,dA_d------�'6' ------------------ �p <br /> ---------------------tA .0 ( 4 4-a <br /> ----------- <br /> --------------- -------- <br /> -------qf_11clu - ----- - <br /> ----------------------------------------------------------------- ----------------------------------------- ----------------------------------------------- <br /> --------------------- - --------------- - ------------------------------------------------------------------------ <br /> FINAL <br /> --------------------------- <br /> FINAL INSPECTION <br /> ----------------------- Date------------------ <br /> I ------------------ -------------------- <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 8-51 Revised W-2100 <br />