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APPLICATION FOR SANITATION PERMIT Permit No.0---0_7_�_ <br /> (Complete in Duplicate) see <br /> Date Issued <br /> Application -rict for a permit to construct and install the work herein described. <br /> plication is hereby made to the San Joaquin Local Health Disi <br /> application is made in compliance with County OrdiDai4ce No. 549. <br /> DID <br /> JOB ADDRESS �ND L CAT] _5arn ----0_6--- ------ <br /> Owner's Name---U----------------- - ------ ---------- ----------- <br /> ------------------------------------- Phone ------ <br /> ------------------- -- ----------- ----- -------------------------------------------- <br /> Address -- ----------- --------- ----------- ---------------------------- <br /> Contractor's Name--- ------------------ --- ------------- - --------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial [] Trailer Court E] MotuE] Other E] I <br /> Number of living units: ---I--- Number of bedrooms _7V__ Number baths _1---- Lot size __qZ70------- --------------- <br /> Water Supply: Public system 0 Community system -0 Pr Number <br /> to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand GravelE] Sandy Loam E;K Clay Loam E] ClayE] Adobe �ardpan 0 <br /> Previous Application Made: Yes E] No 7New Construction: Yes 091*"No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pub[ii s war is available within 200 feet.) <br /> Se Distance from nearest Di,ta=O fr0r1i ifoun-d4ion-10----------MafE41 <br /> P No• of compartments _J X %� I------ atR <br /> ----------- - --- Si,e-C-----------q---Xc�-------Liquid deRfh---- L,------ - ------Capacity---- --0--0 <br /> ..01 ----r- -_/--- <br /> Dis Field: Distance from nearest welL__ _0----Distance from foundation 2jt Distance to nearest IcXne,_ C5 <br /> I Width of trench________ 0 ----------- <br /> E;"" Number of lines________ --------- Lengfh of each line--------L It-7 I .- --____ <br /> of filter mate ____;,_J_Septh of filter material---- - --------Total length________ ___ __ __________________ <br /> Seepage <br /> isr <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________. Vx <br /> 171 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----------------_--------------- C> <br /> Cesspool. Distance from nearest well_________________Distance from foundation--------------------Lining material-------------------------------------- <br /> El Size: Diameter--------------- - Dept h-----------------------------------------------------Liquid Capacity----------------------------gals. <br /> o ' ' <br /> Privy: Distance from nearest-well __________________:- _______._________-.-__Distance rm �ea�*f'� rest building----------------- ------------ <br /> FDistance to nearest lot line--------------------------------------------- <br /> Remodeling aid/or repairing (describe):--------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------­-----------------------------------------------------------------------------I----------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------I--------------------------------------------------------I <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Sign -----------------------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:-0- �-----------------------------------(Title)--------------------------------------------------------------- <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_ <br /> -- ----- ------------------------ ------------------------------------------------------------ DATE!- ------------------------------------------------ <br /> REVIEWEDBY-------------------------------- - ------------------------ --------------------------------------------------------------- DATE---:::-;—------------------------------------------------ <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------- <br /> Alterations and/or recommendafions---------- ------------ - --------j-------------t�lr ----- -- ----------- <br /> .............. --- ------------ - -------------- <br /> A ----------------------------------- (A4rj <br /> ----------X ------tv --- ------Q,44- - � ------ <br /> -e- <br /> -------------- --------10- ----------------�__74 <br /> f----------------------- - ----------- ------------- ----- <br /> -- ----- - ----- - <br /> -------------- 01_A� --- <br /> 16 - ----- - ----- - -------------------- <br /> FINAL INSPECTION BY----------------------------- ------ <br /> ------------------------ Date-------------- ------- -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Streof 300 West Oak Street 132 Sycamore Street 814 North "C" Sfroef <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M B-51 Revised W-2100 <br />