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APPLICATION FOR. SANITATION PERMIT Permit No.,, <br /> (Complete in Duplicate) Date Issued,.,-- _2!2- <br /> All <br /> o <br /> t' construct and insta[l the work herein described. <br /> Applicati6ri is hereby made to the San Joaquin Local Health District for a permit <br /> This application is made in compliance with County 40di, ce No. 549. <br /> 0 <br /> el.04_A�l---- <br /> Jip ------ <br /> JOB ADDRESS AND L <br /> Ph <br /> ATION-4 <br /> -------- --------------------- <br /> one /l <br /> ----7------------- - ------------------------- <br /> Owner's Name---------- ---- ---- ­ -_ :-- <br /> Address------------------ -- ------------- _ew---- ----- ---------------------------------------------------------------------- <br /> J� <br /> Contractor's Name--------------------------------------------------- -------- --------- --------- ---------- -------- Phone- <br /> Installation will serve. Residence parfment'House El Commercial 0 Trailer Court 0 Motel E] Other E] <br /> ............. <br /> Number of living units: J--- Number of bedrooms :74�_ Number of baths Lot size <br /> Water Supply: Public system El Community system -El private E—gepth to Water Table <br /> ft- <br /> Character of soil to a depth of 3 feet. Sand M Gravel F1 Sandy Loam El Clay Loam fft—C-lay E] Adobe E] Hardpan El <br /> Previous Application Made: Yes El No E] New Construction: Yes E"o El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest well__J�---Distance from foundanon___.______-_-____.30 <br /> Septic Tank: 1 - d depth--------5------- -------Capacity_ <br /> . -----Size-----....... --------Liqui I <br /> No. of compartments--------- Z Distance to nearest lot line_______________-"-- <br /> -arest well---SO------Distance from found f <br /> Disposal Field: Distance from nearest "TOG Ich I----------------- <br /> 5 ---------- ---.�ength of each line-- ---Width of trei --- <br /> Number of lines------ ------- ------------Total length--------4�_4------------------- <br /> Type of filter material �'Depfh-of filter material---Ap <br /> ---------------- <br /> Seepage Pit: Distance to nearest Well----------------------Distance from foundation-------------- ---Distance to nearest lot line <br /> 0 Number of pits------------------ --Lining material-----------------------Size: Diameter-----------------------Depf h--------------------------------- <br /> Cesspool: Distance from nearest well______._--______Distance from foundation-_--____._-____Lining, material_--_________________________________ <br /> El Size- Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity-------------------------- -gals.. <br /> I <br /> -from,ne­arest-buiid'1ff�-_---__--­----------------- <br /> __'Distance F <br /> PrivDif rom_nea_��St:well-------- z--------- ---------1----_.-_�__.� <br /> — I - ------------------------------------------------ ----------------------------------------- <br /> Distance to nearest lot line----------------------------------------------- <br /> --- <br /> ----------- <br /> Remodeling and/or repairing (describe):------------------------------------------ ------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------­-------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------------I--------------------------------I--------- ------------------------------------------ <br /> -------------- ------ ---- ---- - ----- - <br /> -------- ------ --- ----- -------- <br /> ---------I__ <br /> hereby certify have prepared t-his.application-and­that__t-he__work--__will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rule) and regulations af\fhe San Joaquin Local Health District. <br /> ................. wner and/or Contract---------------(O <br /> (Signed)-----------------------------------/0 ------------ -------- ---------- <br /> (Title)------ ------------------------------------------------------- <br /> - ---------------- <br /> ----------------------------------------------------------------- - <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------------ ------------------------------------------- --------- ------------- --------------- DATE------ ------ ------- --------------------------- <br /> DATE---------------------------------- ------------ <br /> REVIEWEDBY----------------------------------------------------------------- --------------------- DATE-------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------ --------------- - <br /> Alterations and/pr recommendations------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------I----------I-------------I--------------- <br /> ----------­-------------------------- ---------------------------------- <br /> ----------------------------------I-------------------------------------- <br /> -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------ --------------------------------- ---------- <br /> ----------- ---------------------------------------------------- <br /> -------------------------------------------------------------------------- I---- ---------- - <br /> �------------------------------ ------------------ -- -----I------------ - <br /> ------------------------------------------ -------------- --- ---------------------- <br /> ate--"".-- --------------------- <br /> FINAL INSPECTION BY--- ----- ----------------- -------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 scamore Street 814 North "C" Street <br /> 130 South Sfreet 300 West Oak Street y <br /> h' <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />