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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica'i-ion is.hereby made to the Son J.oaquin 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. <br /> JOB ADDRESS AND LOCATIO <br /> o44--ex, <br /> ------a--• •• ' <br /> Owner's Name------------ --------------------------------------- <br /> - �4_4_ A <br /> -------- ------ ------- -------- Phone------------------- <br /> Add ress <br /> hone--- ---------------Address------------ <br /> Contractor's Name------------------------(3/—Apartment House <br /> _----------- ---------------- --------------------------- ---------- <br /> Installation will;lserve: Residence House E] Commercial E] Trailer Court [3 M o.fel E] 'Other----------------------- <br /> op <br /> Number"of living units: Number of bedrooms Number of baths __/__ Lot size 4F60 <br /> Wafer Supply:'! Public system Community system [] Private 9+-15'e_pfh to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand <br /> i� ] Gravel Ej Sandy Loam Loam E] Clay Adobe[I Hardpan <br /> Previous Application Made: Yes Ll No 2----New Corfsfrucfion: Yes P_<OE] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> �(No,sapfim-tank-:or-cesspAql.permiftedrifpu6liclpewpr-is..availabipw7tthin-2QOfeiet.)i-- <br /> =7` <br /> Septic Tank: li Distance from nearest well.." ------Distance from foundation_... ----- ----Material_ <br /> --A~_ --- ----------------- <br /> Dd 1� No. of compartments------- 44,�_ <br /> Liquid clep�h--- - _ <br /> 2�_ _Capacity_ _119­�------- <br /> Disposal Field: Distance from nearest well_. <br /> _--Zistance from founc1afion____ZZ7..------Distance to nearest lot line-Z4." <br /> A Number of -------- <br /> Length of each line----------r4p-- -----------.-.Width of trench-- <br /> Type of fitter material-.S,- <br /> ��kl)epth of filter material..../_ Total length.._..-Xao;p----------------------- <br /> Seepage Pit- Distance to nearest'well......................Distance from foundation--------------------Distance to nearest lot line <br /> 1­1 Number of pifs-----------------------Lining material----------------------.Size: Diameter-----------------------Depth-------------------------------- <br /> Cesspool: Distance from nearest well...".....___--- Distance from foundation-------------------Lining material---- <br /> ❑ Size: Diameter-------i -- <br /> ----------------- -----------Depth---------------------------------------- ----------Liquid Capacity---------------------------gals.----------------------------------- <br /> W <br /> Privy- Disfance from nearest well.......................".-__---__..____.._"-----Distance from nearest building...-__-----....__--- <br /> ❑ 'Distance to nearest �of line ----------- <br /> --------------------------- --------- --------------------------------------------------------- <br /> Remodeling and/or repairing (describe):---------------- <br /> -----------­-------------J�-------------------------------------------------- --------- ---------------------------------------------------------------------------- ------------------------------------- ------------- <br /> 1; <br /> --------------------------1-_;� I ----------------------------------------- ----------------------------------------;-------- ----------------------------------------------------- <br /> -------------------------------*----------------*----------------*-------------------------------------------------------------------------------------------- - <br /> --------------------------------==---------------- -------------- + i <br /> ---------------------*-------------------------------------------------- <br /> -- -- ---- - - <br /> I hereby certify that I have prepa.red thisapplication and that the work will--b-e--d-o-ne-'in--accord-a-n-ce-,w-ith--San--J-oa-quin---County- JP <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)_...• ----------------------------------- --------------------- ----------------------------------I <br /> �Z­v I---------- ----- _(Owner and/or Contractor] <br /> ----- ........... <br /> (Plot plan, showing size of lot, location of sys�e__r`r in relation to wells, buildings, etc., can be placed on reverse side). <br /> EP�AJRTMENT)4SE ONLY <br /> APPLICATION ACCEPTED�BY----- - <br /> - - ----- - --- <br /> ------ ---------- DATE--- <br /> REVIEWEDBY--------------------------------------------- ---------------------------------- ----- -------------------------- ------------- DATE <br /> BUILDING PERMIT ISSUED"----------------------------------- -------------------- DATE <br /> ........................ <br /> Alterations and/9:"r recommendations:..----------------- <br /> I ---;­ <br /> ---------------------•--------•--------•-------•------ 7 ------------ <br /> -------- .4 <br /> --------------- -------------------------------------- ------------ <br /> -------------------------I-------------------------------------------------------- ------------------------- -------------------------- <br /> --------------•---------.---- ---------•------------ <br /> --------------------------------------- ------ --------------------------------------------------------- --------------------------- ----------------------- <br /> ----------------------------- ----------------- ---------------------------- -- --------------------- ---------- --------------- -------------------------------------------------------- ------- -----------I-------------- <br /> -------------------------------------- ----------------------------------------------- ---­--------------- ---------------- -------------------------------------- <br /> --------------------------------------- <br /> FINAL INSPECTION BY:---------- Ic W_ <br /> ----------------- Date <br /> ------------ <br /> -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, C I;alifornia Lodi, California Manteca, California Tracy, California <br /> ES-3-2W 14s446 <br />