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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Ooica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Ap ii c <br /> This application is made in compliance with County Ordinance o. 549. <br /> Ordinance <br /> e 0, 5"9, <br /> 1 LO <br /> JOB ADDRESS AND LO TION ------------------------------------ <br /> ........... <br /> Owner' Name ---- ----- - - ------ - --------------------------------- ----- -------------------------------------- <br /> r <br /> Address-- -- ---- -- -------------------------- ---------------------------------------------- ------------------------ <br /> ------------- - <br /> Contractor's Name------------- -------- ------ _e ----------_---- ------------ Phone—V <br /> Installation will serve: Residence Apartment House <br /> ] Commercial 0 Trailer Court E] Motel F-] Other E] <br /> Number of living units: /"!"'N_urnber of'bedrooms 7c.;Z �N_Umber_.T Lot size -------------------------- <br /> Water Supply: Public system x Community system [] Private Ej Depth to Water Table4ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel Ej Sandy Loam [] Clay Loam [3 Clay [] Aclobe)S( Hardpan E] <br /> Previous Application Made: Yes 0 Nox New-Construction: Yes-0 No.kr I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 6 1 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sepfic Tank: Distance from nearest well_________________DisfaAce from founclation---------------------Material------------------------------------------------- <br /> No. of compartments------ --- ---- ---.Size-------- -----------------Liquid depth------------ - - ------- -Capacity-•-------------------- <br /> Yispcsal Fief Distance from nearest well____.;-_-._..-_Distance from foundation--------------------Distance to nearest lot line_________________ <br /> �,1� <br /> Number of lines-----------------------------------Length of each line--------.1------ ----------.Width of french------------------ ------- ---- <br /> Type of filter material-______----___.-__ epth of filter material._______________--___Total-_-Total length-------------- ------------------- <br /> Seepage Pit: Distance to nearest well_?&�/�Distanc_6� dafion---4/ Distance to nearest lotline--- ------------ <br /> Number of pits....../-------------Li-ning material __:.Size: Diameter--. 13-- Depfk____,:Wg_ ------- <br /> 3K I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation..-.__ ---------.Lining material-- - -------------------------------- <br /> F1 Size: Diameter-------- -----------------------------Depth---------------------------------------- ±-----Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------- ------------------------------ ---------Distance from nearest building____.__-_-.__--_---__________--_____-_--. <br /> ❑ <br /> uilding----------------------------------------- <br /> ElDistance to nearest lot lin)e-------- -------- - - ----------- -------------------------------------- --------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):--------- ----------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------­_­......I——--------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- ------------------------ <br /> ----------------------------------------------------------I------ ------------------------------------------------------------------ ------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- -------- <br /> I hereby ce <br /> ,�!ify that I have prepared this application-and that the work will be done in accordance with San Joaquin County <br /> ordinances, �+' f I ws,and"ruiles end regulations of th6 Sa Joaquin Local Health District. <br /> ,�Sf Te, la <br /> - --- --- -- -- Owner and/or Contractor) <br /> (Signed) -- ----- �, ,4------- ------ ----- - ......--------------- -- <br /> 7 z/ �= 1 --------------------- - --------------- <br /> By:-----_-------------------------- -- ---- --- -(5�------------. Title(Ti --- <br /> (Plot plan, showing size of lot, Iota -Ibn of system in relation to W611 uildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- <br /> - --- -- - -- DATE--------------------- ----------------------- <br /> REVIEWED BY-------------------------------- ----- -------------- -- - ---------------------------------------------- DATE----- - <br /> --------------- -- - -------------- ............... <br /> BUILDING PERMIT ISSUED------------------------------- <br /> DATE---------------- <br /> ---- --------------------- ------------------ <br /> Alterations and/or recommendations:---- ----- - --- --- --------------------/---------------------- ------------------------------I ----------- ...... <br /> -------------------------- ......... <br /> ----------------------------------- <br /> -------------- ----------- ---------------------------------------- --------- ........... <br /> ---------- <br /> ------------------------------ --- --- --------------------------------------- -------­---------- <br /> --------------------------- -------------- <br /> --------------------------- ------------------------------------------I....... ................. -------- ---------------------------I---------------------------------------------------------------------------- <br /> FINAL INSPECTION -------- --- Date----CT-___z_ --------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Stree+ 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9 145446 ATWPUD <br />