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APPLICATION FOR SANITATION PERMIT <br /> P mit �o. <br /> Date Issued <br /> (Complete in Duplicate) <br /> Application 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. /lIIAL- WNl7',E' <br /> . / ----- -- ,% . <br /> J08 ADDRESS A LOCATION_�__YY-�---- �'/�I��-._--.�1��'_+ ----- � -���----• <br /> � ff Phone -- <br /> Owner's Name-- -----•--- 1.1/ -( h - <br /> Address-•----------------------- --- --- <br /> ------ - <br /> -__x <br /> �n f Phone_C--� - `------- <br /> Contractor's Name----•-----•------•----------•---- --1�_�!�-af;Ls�-LI--�---�'��`------------------------------------------------ /�---- -- <br /> Installation will serve: ResidenceA Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I------ Number of bedrooms _f. -- Number of baths <br /> 1----- Lot size --- ---------- ------------------ <br /> Water Supply: Public system E] ` <br /> Community system ❑ Private ]� Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam El Clay Clay Loam' Clay [IAdobe f� Hardpan E3Previous Application Made: Yes ❑ No X New Construction: Yes E] Nox ' \\ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> �/��a ------- <br /> I Septic Tank: Distance from nearest well_/.2�--Dista nce from ou-nidation__ -- --Capacity_go --6;40 <br /> -----size �O _rrk#- iquid depth <br /> No. of compartments_--- ------ s <br /> G Distance from foundation_-.------Distance to nearest lot line_______. y <br /> Disposal Field: Distance from nearest we11_ -- ----_-Width of trench__--A�-------- <br /> - Number of lines-------�1_' -�--------Length of each line------ _�i'�-`_�i , <br /> Type of filter material/-/"1 � ___Depth of filter materiaL__� -- ------- length.----- --------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundat ---------------- to nearest lot ine___._________-._ <br /> ❑ Number of pits---------------------Lining material-----------------------Size: Diameter----------------------Depth--------------------------------- <br /> Cesspool- Distance from nearest well-----------------Distance from foundation-------_________--.Lining material-------------------------------------- <br /> F-1 <br /> ❑ _Liquid Capacity---------------------------- <br /> Size: Diameter-------------------------- -----------Depth-------------------------------- --------- ------ g <br /> Privy: Distance from nearest well............. -----------------------------------Distance from nearest building-___________.----------------------•----- <br /> Distance to nearest lot line---------------:--,.----------------------------------------------------------------------- <br /> -------------------------------------------------- <br /> ----- ------ <br /> Remodeling <br /> -- 1 <br /> Remodeling and/or repairing (describe):__-____ ------------- ---- <br /> ---------------------------­- <br /> -- -' w <br /> ------------- <br /> ---------------------••---•----------------------•----•------------ <br /> -------------------------------------------- <br /> --- <br /> Papplication I hereby certif hat I have re are t is a lication and that t e work will be done in accordance with San Joaquin County <br /> ordinances, ` law , and rules and regulations of the San Joaquin Local Health District. __4 <br /> ------------- --------- (Owner and r c <br /> o Cont actor) <br /> -----��- A <br /> (Signed) E. <br /> ---------Title------ - - - - ------ <br /> (Plo# plan, showing site of I , location of system in relation to lls, buildings, etc., can be pla on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- ----- --.-`�--- _ DATE <br /> ------------------------ - <br /> -Z <br /> -------------- ----- DATE__ r ;�;- <br /> - - ------------- <br /> REVIEWED BY--------------------------------- - DATE------------------------ ---- <br /> f f <br /> BUILDING PERMIT ISSUED---------- ----------------------=----------- <br /> Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------- <br /> ------------------------------------------------ <br /> ---------------------------------------------------------- ------ ----- <br /> ----------------------- --------------------------- ------ -- <br /> -------------- -------------------------- -------------- - <br /> - <br /> Date-------f------ --------- ------------- ------------------------------------ <br /> - --- <br /> FINAL INSPECTION BY:-- --- -- --- <br /> --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 S camore Street 814 Nor+h "C" Street <br /> 130 South American Stree+ 300 West Oak Street Y Trac <br /> Stockton, California Lodi, California Y. California <br /> Lodi, California <br /> ES-9-2M 8-51 Revised W-2100 <br /> t A - <br />