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X4, APPLICATION FOR SANITATION PERMIT Permit No. - - <br /> $ � � <br /> (Complete in Duplicate) - Date Issued <br /> Applica4ion 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. 5.49. <br /> JOB ADDRESS AND LOCATION----- _.._.!__.__G__f�- ........ .....lrn�e.�....... <br /> �.9r .._. <br /> ` ••-- _-------- <br /> Phone... .. . . ...... <br /> Owner s Name._.._... l - -------------------•---- , <br /> !!3 ...................................----•--•••--•••--•••-•-...-••--...... <br /> Address-------------- . . --- <br /> •-••--......••....... Phone. r 1�. • <br /> Contractor's Name_.-- -._ - 0 <br /> Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_ ._ Number of bedrooms _ .. Number of baths 1-21C­Lot size ._._.. <br /> Water Supply: Public system E-71 Community system ❑ Private �epth to Water Table&..Z) . <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay;L•ccram [I Clay ❑ Hardpan❑ <br /> Adobe.t <br /> 11 <br /> •,; <br /> Previous Application Made: Yes ❑ Nom New Construction: Yes �K-Non <br /> 4�Y <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank,or cesspool permitted if puwirsewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well. <br /> Distance from foundation.../d...........Material....Iv'_-E, .......-- <br /> No. of compartments__-- Size..a.d�.._....... - _.Liquid dap%h...-- •t?-......-_--..Capacity_..__1�v ...-.. <br /> 'i 7 .__.Distance to nearest lot line__,;;221: _` <br /> Disposal Field: Distance from nearest well... ......Distance from foundation_..,...y_..._. <br /> Number of lines.___..__-_ __.-.-�1.--• -�.. Length of each line-------`�_..,�1...... j...-Width of trench______ _ __ __ <br /> Type of filter matenal..` ....�.`3.!Depth-of filter material $__.�.�Total lengt __.__._.. <br /> t <br /> * " /�Q.__...Distance from foundation.... + .-_..Distance to nearest lot line--- <br /> Seepage Pit: Distance to nearest well_/f . <br /> Number of pits.._1'-• 9 �� <br /> Linin' matenal._SiD...e- <br /> ..I -'` `fie Diameter.- <br /> Cesspool: Distance from nearest well............:....Distance from foundation....................Lining material.......................... <br /> '•'gaIs. <br /> 1771Size: Diameter-•----------------•-•-• ...__......Depth........--••---•--:-- •-••-.---•------•-- ---------Liquid Capacity...................... <br /> Distance from nearest well................ .........•--.----••.--..-.-_.Distance from nearest building._.--.------------------------------------ <br /> Privy: <br /> ---••--•---••-•...................•......._.._.. <br /> F-1 " ' Distance to nearest lot line-................. -••••-•••••-•-••---•--'•. <br /> - X11 <br /> Remodeling and/or repairing (describe):••....-•-•••-••-••-•-...•-•-•-•••....•....................•--•---•-----•...-•••-•-•-•--------•••------••--••-•-••-•---...............•--- <br /> -•------- <br /> • .................................. --••--- <br /> ....:.._.....__•_•-------------------------------------------V.6...............-_•__•_`_••_-_r•_____..._....._._._.........._..__..._•___••_-_...____.-................................................................ <br /> ... <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, Stafe a s, d rules and regulations of the'San Joaquin-Local Healfih District. <br /> ............................(Owner and/or Contractor <br /> d/o <br /> -------/� <br /> - ........ -----------------{Title) <br /> By:...;6;.2r _ -w <br /> (Plot plan, is srze of-lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...................... DATE------- ..�.� ..----V �_._..._. <br /> • -----•--•---•. DATE-----------------------•-• ---•------------ <br /> REVIEWEDBY............. ------------------- -------- ----- -- <br /> . <br /> BUILDING PERMIT ISSUED-------------------------------- --- <br /> �---•------- --------•------------••- <br /> ...................................... DATE............. <br /> Alterations and/or recommendations:..................................... ------•-•--•`..................................•-•-•------.......................•----------------------- <br /> .....---..._.............--••••-..... <br /> ---------•----•-------------------------------------------•-.---------•------•---- <br /> ................ . <br /> . ......... <br /> F ................................... <br /> FINAL INSPECTION BY ....... -- ----- •-----•-..------------ Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamoro Street $14 N*rth "C"Street <br /> Stockton, California <br /> Lodi, California Manteca, California Tracy, California <br /> w_,)i nn <br />