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APPLICATION FOR SANITATION PERMIT Permit No. .-.----- <br /> (Complete in Duplicate) Date Issued --- ------- <br /> lication is hereby made to the San Joaquin Local Health District for a permit to con trust and-install f e work herein described. <br /> his application is made in compliance with County Ordinance No. 549. <br /> c, for a perm it to con 'ruc, an d,in <br /> st' <br /> 149 <br /> ------------- <br /> JOB ADDRESS AND L ATI ----------- -- --------e--- --- ---- ------------- - - - ---- ----- ------------------------ -------------- <br /> Phone--.?----- <br /> ---- --- ----------------------------- <br /> ----- - ------ - --------- <br /> Owner's <br /> --------------- ............. ------------------- <br /> ..................... ............. <br /> Address ------------- ------------------------------------------------------------------ <br /> Phone__.�i? <br /> ------------------ <br /> Contrac�t­or's�-Name------------------ <br /> ercial E] Trailer Court [] Motel ❑ Other <br /> Installation will serve: Residence Apartment H� se E3 Comm <br /> - 0�1 <br /> ❑ <br /> Number of living units. __Number of bedrooms 9Z_ Number of baths /--- Lot size --------------- <br /> Water Supply: Public system Community system El Private F] Depth to Water TableoAd ft. <br /> X, m E] d Hardpan E] <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel E] Sandy Loam El- Clay Loa Clay ❑ A olql� <br /> Previous Application Made: Yes 0 N OX New Construction: Yes <br /> El <br /> k. No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> # <br /> Septic nearest well-_�;040----Distance from foundation-- _______________.Material---- ----- .. .... ...... ------ <br /> Tank: Distance from rt <br /> __'7-Capa <br /> No. of comparfrrients--Z V <br /> ----------- ----Si,e_45; V --Liquid depth <br /> _. 1-- <br /> Field: Distance from nearest well.... �51Q----Distance from founclafion__,-,-�------IF----Distance to nearest lot line <br /> Number of lines___----/--- -------------------Length of each line__-----_--. a 49------Width of trench...... ----------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length-_____----_------.-----_---____-_-----.-to <br /> Seepage Pit; Distance to nearest well---------------- ---Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ElNumber of pits----------------------Lining material--------•-----.--------Size: Diameter--.------.-------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---.- -_-.____Lining material_-.---.-.__---.----____----_-._---__ <br /> ❑ <br /> aterial------------------------------------- <br /> ElSize: Diameter------------------ ------------ ------Depth--------------------- ------ ----------------------Liquid Capacity----------------------- ----gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------.---------------------------. _`tea <br /> ❑- <br /> uilding------------------------------------------ <br /> El- Distance to nearest lot line--------- --------------- --------------------- ---------------------------------------------------------------------------- ------- <br /> Remodeling and/or repairing (describe);--------------- ----------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------- <br /> ---------------­-­-I----------------- --------------------- ---------­----------e------------------------------------------------------- <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 s, and e nd regulati s f the San Joaquin Local Health District. <br /> ------------------------------------------- -(Owner antractor) <br /> 0 Ile, <br /> ------(no ---- --------L—------- - L <br /> (Signed)------------ ------ - -- ------- -By----------------------- ---------- ------ <br /> ed on reverse si4e <br /> (Plot plan, showing size of lot, a i n of syst I relation fo wells, buildings, etc., can be�A <br /> FOR DEPARTMENT USE ONLY <br /> tb, /-�1 <br /> APPLICATION ACCEPTED BY-- DATE-----------0/41,5 1_r----------------------------------- <br /> TE------------------------------------------------------------ <br /> ---------- ---------------- <br /> REVIEWED BY------------------------------;-- - --------- ------ ------------------------ ------------ DA <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------- <br /> Alteeafion andor recommendati*ns:-- -----m -------------------------------------------- <br /> ------------- <br /> --------------------------- ------------------------ <br /> zr k-, A�� - ---k. f ------------- <br /> I YAl <br /> ---- ------ <br /> 44- - -----:7:!;�:---------Aj_- <br /> ----- ------------------------------- -------- ---------------------I--------------------------------------------- <br /> ------------------ --------------------------------------I------------------------------------------- <br /> ----------I------- --------------------------------------------------------- --------------------------- ----------------------------------------­------- ------------------------------------- -------------------------- <br /> ------------------ ---------------------- -- --------------------------------------------------------------- --------------------------------- ----------- ------------------------------------------------I.,q_. ., ------------- <br /> I <br /> ------------------------------------ <br /> --- <br /> FINAL INSPECTION BY:.----- '' -------------------------- <br /> Date <br /> 4 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Cal Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />