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.� APPLICATION FOR SANITATION PERMIT Permit No. ........ <br /> (Complete in Duplicate) Date Issued <br /> Applica{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 in compliance with County Ordinance No. 549. <br /> �/ J <br /> JOB ADDRESS AND LOCATION------------- ---- --?_-------- --U._--__-v-- -- - - -- <br /> Owner's Name----- _--•------- ------------ ----------------------- ---- ------------------------------- ------ Phone------------------------------------ <br /> Address-.--•-------�..T�_._113 D---------_.4 ------- &_A/,V_Z <br /> Contractor's Name - ------------a7-�"srY�------------------------------------------------------.--- Phone-------------------------_------ <br /> Installation will serve: Residence .,.Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/___ Number of bedrooms ___�-Plumber of baths J..._ Lot size -------- ----------------- <br /> Wafer <br /> _________________ <br /> Water Supply: Public system O—Community system ❑ Private ❑ Depth to Water Table i�G_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe O, Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 25— New Construction: Yes A No ❑ <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 /> ❑ of compartments------ --- -- ------- ----Size------•--------•----------------Liquid depth--------------------------Capacity---------------------- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation-----------------_Distance to nearest lot line___________..__. <br /> ❑ er of lines-----------------------------------Length of each line------------------------------Width of trench-------•--------------------------- <br /> Ty e of filter material---------------------_...Depth of filter material---------------------._Total length_______.________________---_________-__._ <br /> F <br /> Seepage Pit: Distance to nearest well--__�40–,H�Distance�from foundation___ ._._..Distance to nearest lot line....�d___�__ <br /> - Number of pits.____:%___.._._.__Lining material__A9ff_G/<----Size: Diameter.------i s __.D e p -------OL1.5----__ ---- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material-----------------.------___________--. <br /> ❑ Size: Diameter------ ------------------------------ Depth------------------------------------- ----------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------- <br /> ,�• <br /> ❑ Distance to nearest lot line--------- --------------------------------------•---------------- <br /> Remodeling and/or repairing (describe)-------- --------------------------- ----------------------------------------•---------••-•--•-- --------------•------------------ <br /> ---------•---•-----------•---------------------------------------------------------------------------•-----•-------------------------•---•---------•----•---•-----------------------------••----•---------------------------- <br /> ----------------------------------r--------------------------------------------------- -•--------------------------------•-- ••-----------------------------------------------------------------------..------------------- <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 , and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------ ------ - --- -- -- --- ---- - -- --- • --- - -----(Owner and/or Contractor) <br /> c <br /> By:------ <br /> -------- ----- --------------------------Ti+le - ---­------------------------- <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------------------------r-y- --------------------------------------- DATE------. _ _ <br /> REVIEWED BY-------------------------------- ----------------- ------ DATE <br /> ----------------------------------- <br /> BUILDING PERMIT ISSUED_-.------------------------------------ --- DATE.------------ ---�-= <br /> Alterations and/or recommendations:--------------._. N -------- ._ <br /> ---------- ------------ -- ---------------------------------- `---------•------------- <br /> r ... <br /> '' - ---• -- <br /> --••-------•------------• --- -- ----•---------------- ��.' <br /> ----------• --------------------- ----------------------------------- - •------------------------------- ------------------------------------------------------------- -------------•-------------------•--------------- <br /> FINAL INSPECTION BY:----------- .—C----------------------------- Date.-- ... 5 r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockfon, California Lodi, California Manteca, California Tracy, California <br /> ES-9 ,45456 ATw000 <br />