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APPLICATION FOR SANITATION PERMIT Permit No. -4 --------- <br /> (Complete in Duplicate) Date <br /> gA -ion is hereby made to the San Joaquin Local Health District for a permit to constru*Zt=nd'install­fk�e'work Herein described. <br /> plica4 <br /> This <br /> application is made in compliance with County Ordinanc o. 549. <br /> - ------------------------- <br /> JOB ADDRESS ANDL CATION------------- - ----- ------- <br /> A -- ---- <br /> Owner's Nn /,a-. ------ - ----- -- -------- -- - - - ------------------------------------ -- Phonel�_ <br /> Q- ----------- --- <br /> ------------ <br /> Address. - ---------------------------- -- --------- <br /> ----­---------------- --- - ----- <br /> ------------------- <br /> Contractor's Name------------- ------ry ------ -------- ----------- ---------------------------------------------------- Phodn ---- --------wil_­_I�r <br /> Installation will see: Residence Apartment House E] Commercial E] Trailer Court 0 Motel Other h <br /> Number of living units: _/---- Number of bedrooms 24n- Number of baths --,)---. Lot,'size -, -------- ------------------- <br /> Water Supply: Public systemX Community system E] Private [] Depth to Water Table. ft. <br /> I I to <br /> Character of soil to a depth of 3 feet; Sand E] Gravel [-] Sandy Loam E) Clay Loam [] Clay E] AdoE Hardpan 0 <br /> Previous Application Made: Yes 0 No New Construction: Ye)� No <br /> TYPE OF INSTALLATION AND SPEC(FICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> epfic T k: Distance from nearest well_________________Distance from foundation--------------J_Material-------- 14 <br /> --------------------------------- <br /> No. of compartments------------------------ ------- <br /> ------------------ <br /> --Size--------------------------------Liquid dep�h--------------------------Capa:ci!R----- <br /> Disposal ie Distance from nearest well--- -- --- -----Distance from foundation--------------------Distance to nearest lot,line----------------- <br /> Number of lines-----------------------------------Length of each line <br /> -------------------------`---Width of trench.--------- -------------- ---____-- <br /> Type of filter`ateriaL----- ----- <br /> -----------Depth of filter material-------------------!---Total lengthA------------- ---------------------- <br /> ------------- <br /> Number of pits_j---------------Lining materi Siz e: Diameter_ <br /> Seepage it: Distance to nearest wel�,_�__ _ ----Distance fsom fqpndation--- to nearest lot line_____5-­ V1 <br /> ---,?-------------- ---------------- <br /> C - A ---- I <br /> Cesspool: Distance from nearest weld-----------------Distance from foundation--------- t_:....Lining material--.__.___--- .----.-_--------- <br /> 171 Size: Diameter--------------------------------------Depth------------------------------ -----------------I---Liquid Capacity-- -------------------------gals. <br /> # It <br /> Privy: Distance from nearest well-- :-----------------------------------------Distance from inearest building_-._____-_-----___--'-__---__---__----_-. <br /> ❑ <br /> uilding------- ------------I--------------------- <br /> El Distance to nearest lot line---. � I i I <br /> ----------------------------------- --- ----------------------------------------------------------------- ------------------------------ <br /> Remodeling and/or repairing (describe):_. ------- --- -------­ ----- - - - --- ---- ------ -- ----- <br /> --------------------------------------------------------------------- ------------ <br /> ------------------------------------------------- ---------------------------------- ------------ -------------- <br /> ----------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- <br /> I hereby certify f1hat I have prepared This application and that the work will be done�in accordance with San Joaquin County <br /> ordinances, State law �n d rule nd egulations of the San Joaquin Local Health District. <br /> (Owner an or- <br /> I <br /> {Signed)---_ --- ----- ------ -- ------- -------------------------------------------------------------- ------- Contracfor) <br /> By:------------ ---- ----%------------------------------------------------------------------------------ - - ----- I..... . <br /> %7 ------- <br /> cat on of sysf e m in relation f o wells, ------- ---�reverswl sle <br /> (Plot plan, showing siz 0 buildings, etc., can b� pJ02�on ee�, <br /> } <br /> FOR DEPARTMENT USE ONLY F <br /> APPLICATION ACCEPTED BY----._------------------ ------------------------------- -- - --------------------------- bATE�---- ----- <br /> REVIEWED BY-------------------------------------------------------------------------J I tobDATE-----------------•------- <br /> ------------- ------------------------------------ -- <br /> BUILDING PERMIT ISSUED---...... ---------------------------------------- ------------------------------------------------- DATE------------------- ------------- <br /> ------------------------ <br /> Alterations and/or recommendations------------------------------------- a . - . <br /> --------------------------------------------------------------------------------------------------- ------------_-------- <br /> ------------------------------------------------------------------------------ ------ -------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------- ------------------k-4 O's: P V, j %. <br /> ---1;---------------I----------------------------------------------------­------------------------------------ ­--------------------- <br /> ---------------- ----------------------------- -----------------------------------------­ ----------------------------------------------------------------------------7---------; ------------------------------- <br /> --------------m-------------------------------- ------------------------------ ------------------------------------------------------------- -------J-- ----------------------------------------------------------------- <br /> Air <br /> Ce <br /> FINAL INSPECTION BY:---- Date------- - --------------------------- ------------------------------ <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 =i Lod;, California Manteca, California Tracy. California <br /> ES-9-2M Revised W-2100 <br />