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APPLICATION FOR SANITATION PERMIT Permit No. .--- --- - <br /> ,I}� (Complete in Duplicate) a <br /> 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 Ordina c No. 549. <br /> � .5__ w��c 4R c - � . -------------------------------- <br /> JOB ADDRESS AND LOCATION________ _ _______ _ <br /> Owner's Name---------------------------------------- ## A RA_11L- ------------ - - - ------------------------------------- Phone----:r7- <br /> Address <br /> hone----:r7— �. ' <br /> Address----------•-------------------------------------S-A-MJC------------------------------------------------------•-•-------------------------------------------•---------------------------- <br /> Contractor's Name---------•------------•--------PAR0tL5--h-------------------------------------------------------------------------------- Phone----57:t-.9A6-40-,7- ---- <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1-___ Number of bedrooms _9j__ Number of baths _j__- Lot size ._-�_2_Q_r__ _�_-'_'7_-------------------- <br /> Water <br /> _______________Water Supply: Public system VC Community system ❑ Private ❑ Depth to Water Tablesyg�Oft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(f Hardpan ❑ <br /> Previous Application Made: Yes ❑ No.9- New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Seu;W'c Ta k: Distance from nearest well-------------____Distance from foundation--------------------Material_______________.____-______________.____.______- <br /> 11'7 No. of compartments---------- - -------------Size--------------- ----------------Liquid depth--------------------------Capacity...--.----------------- <br /> Dis osaI Fi Id: Distance from nearest well-----------------Distance from foundation--------------__._-.Distance to nearest lot line_______.__-_.__. <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench.------------------_------------___ <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length----------------------------------....... <br /> _ <br /> Seepage Pit: Distance to nearest well_JR12 iii_$___--Distance frofoundation_I_w�t-. ___....Distance to nearest lot line------ <br /> C&" <br /> Ix Number of pits._.I____------- g —.-.- --Size. Of <br /> P <br /> Linin material Size: Diameter__._ _ _ De th_.__`.-5_ <br /> -------------- <br /> Cesspool: Distance from nearest well----______-------Distance from foundation---------------------Lining material-___-__.-________________-__.__---_ <br /> ❑ Size: Diameter---------- -------------- '----------.Depth----------------------------------------------------Liquid Capacity----•-----------------------gals. <br /> Privy: Distance from nearesf well------------------------------------------------Distance from nearest building----------------------.------------------. .# <br /> ❑ Distance to nearest lot line-------------------------- --- --- --------------------------------•----•---------------------------------------------------•--- ----- ----- <br /> Remodelingand/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------.......-.----------------------------- <br /> ------------------------------------ •------------••----------------------------•----------- -------------------•-------------------------•-----------•-------------•--•--------------------------•------------------ <br /> - ----- ---------------------------- •----------------------------------------------••------------------------------------ '1 <br /> I hereby cer y that I have janpregulations <br /> this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat la , and r les of the San Joaquin Local Health District. <br /> (Signed)..--•-------- - ---- Vii-- - �Cantractor) <br /> By:....----•------------------------------------ - _­ <br /> •---•--------(Title)- <br /> - ----------------------- 9aflion <br /> -- -(Plot plan, showing size of lot, location of system in r to wells, buildi s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE------- t ------------- <br /> REVIEWEDBY-------------------------- ------------------------------------------------------- ------------------------------------ DATE-------- •--•----------------------------------------------- <br /> BUILDINGPERMIT ISSUED-----•-------------------------------------•-----•-------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations:---------------------------------------------------------------------------------------.---------------------------------------------------------------------- <br /> -------------- <br /> -------------------•-----------------•----------------------------•--•-----------------------------------------------••----------------------------------------------------------•-------------------- -. ------------- <br /> -------•------------------•------------ ---- <br /> 1 <br /> FINAL INSPECTION BY------------- - ------------------------ rsy - <br /> ��� 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 Lodi, California Manteca, California Tracy, California <br /> ES-9-2M ; Revised W-2100 <br />