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APPLICATION FOR SANITATION PERMIT Permit No. F <br /> (It�1(*", ------------ <br /> v (Complete in Duplicate) <br /> Date Issued ......... <br /> N PP licafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> its application is made in compliance with County Ordinance No. 549 <br /> JOB ADDRESS AND LO <br /> ION <br /> ---------- ---------------- ------------------------------- ------------ -- -- --------------- <br /> Owner's Name------------ ------------- - --- ------------I-------------- -------------------------------------------- Pho-,leo; / ------------- <br /> Address------------...... <br /> •----------------------..-.-------------------•-------•------ <br /> -----------------------***-----------------------------------------*-,--,*--------------------------*--------------------------- <br /> Contractor's Name---------------- -----------------------------I----------------------------------------------------------- Phone--- ---;;;� <br /> Installation will serve: Residence Apartment House Commercial Ej Trailer Court E] Motel E] Other E] <br /> Number of living units: Number of bedrooms6* .- Number of bafhs..?--- Lot size <br /> Water Supply: Public systemx Community system F] Private [-] Depth to Water Table.4-10--if- <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy.Loam F-1 Clay Loam El El d <br /> Previous Application Made: Yes [:] N New Construction: Ye-\17f No E] Clay ❑ Adobe Hardpan E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> eptic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material <br /> 10� <br /> eptic Tank <br /> I; No. of compartments------------------------Size--------------------------------Liquid depfh--------------------------Capacity----------------------- <br /> tDisposal ield- Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Number of lines--------------- -------------------Length of each line------------------------------Width of french <br /> Type of filter material-------------------------Depth of filter material--------------..--.-.--Total length---------------- ------- ---------- <br /> Seepage Pit: <br /> Distance to nearest ------Disfance,from dc'unclation------1-1:59----.Distance to neari�s-flo_t line <br /> Number of pits_------/-----------Lining material -- - -____.Size: Diameter___.Z.(,? <br /> Distance from nearest well-----------------Distance from foundation--------------------Lining material.-_.--____.\V_C� DifI ---------Diameter------------------------- Depth------------------------------------_-------------Liquid Capacity------------------------ <br /> El Size: -----gals. 1 <br /> Privy: Distance from nearest well----------------------___------.-._----- ------Distance from nearesr building__---.--_____-------___---_--.----- TI) <br /> El Distance to nearest lot line.-..-_.___----_.--- ----------- <br /> Remodeling and/or repairing (describe):------- -- -------- ------ <br /> ----- ------- ---- <br /> -------------- ---- ---- -------I------------------------------------------------------------- ---------------------- ------ ----------------;/-/------------------------------------------------------------ -- <br /> ----------------------------------__-------------------------------------------------------­--------------------------------------------------------------------------------------------- <br /> -----------7------------y--------------------------------------------------------•---------------------•---------------------------------------------------------L-------------------------------------------------- <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, Stat ws, d les and regulations of the San Joaquin Local Health District. <br /> ws,�Z <br /> o <br /> (Signed)-.------ ---- ------------------ - -------- --------------------------------------------------------------------------- (Owner or Contractor <br /> By:----------- -------- <br /> -----------------------------------------------------------------------------------------------(Tif <br /> --- - ------- - -------------------- <br /> C,g s, <br /> e s <br /> (Plot plan, showi size of lot, location of system in relation to wells, buildings, etc., can be placed on reve i <br /> I — <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- - --------------------------------------------------------------- DATE---------- <br /> REVIEWED BY - <br /> ­---------------------------- -- ---------------- ------------------------------------------ DATE-------------'R ------------------ <br /> BUILDING PERMIT ISSUED-------------------------- ------------------------------------------------------------- DATE-------\1" <br /> Alterations and/or recommendations:------------- <br /> -- ------------- ------------------------------------- <br /> - ----- �<n <br /> --------------------- --------------------- <br /> ------------- <br /> ._6* -------------- <br /> ---------------------------------------------------- - ---------------------- ----------------------------------------------------------------------------------- -- ------- <br /> -------------------------- <br /> -- --------------------- <br /> ------------------------------------------------- ------------------ <br /> --------------------------------------------------------------------------------------- <br /> -IF <br /> ti... FINAL INSPECTION BY:-- ---------------------- Date....... <br /> --------- ------------------------------------ <br /> SAN JO ,QUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oal Sfreef 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> A <br /> ES-9-2M 10-52 Revised W-2100 <br />