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APPLICATION FOR SANITATION PERMIT Permit No. <br /> -. (Complete in Duplicate) iQ <br /> Date Issued -- - <br /> m is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> .ation is made in compliance with County Ordinance No. <br /> � 5 <br /> " � - <br /> DRESS AND LOCATION - - <br /> ••-6--- --------•K----------- <br /> s .. .1 ------}-1--- --�-----.-�--^^--- <br /> Name w TPhone---------------- <br /> -------------- <br /> ------------ ..... <br /> Address------- <br /> bb.............. _.. -'" �/ - tJ <br /> Contractors Name-- ---------------•- <br /> ------------------------------------- -- - --------••------------•-------------------- Phone----•-------•-----------------.�.-- <br /> Installation will serve: Residence & Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f <br /> Number of living units: __✓ Number of bedrooms ._ _ Number o'baths LLot size -------- --------__------ <br /> , <br /> Water Supply: Public system ElCommunity system El Private Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: San Gravel E] Sandy .Loam Clay Loam E] Cay [3 ' Adobe❑ Hardpan El <br /> f�dvious Application Made: Yes E] No v New Construction: Yes No ❑ <br /> _4E OF INSTALLATION AND SPECIFICATIONS: i <br /> N Q (No septic tank or cesspool permitted ifub is sew r is availa6le within 200 feet.) <br /> � <br /> q <br /> ti Tank:-'��_. Distance from nearest welfl"�q:""'"-Dista fro fou ion_�0__ <br /> �} Ma+enia ---------- - <br /> s No. of compartments- A`-T ___-Li ui #_ <br /> Size ------ d e th ----- -- Ca acct --- - <br /> Dispos -1 Field: Distance from nearest well Distance from foundation 119,.L Lance to nearest lo} lI�n��Q�-` <br /> Number of lines__________ ___ ____ Length of each line______._6_0.____ ..t _._ --- <br /> length------------��O------------­---- <br /> _____________ _ - <br /> Se.-page Pit: Distance to nearest weih______________ <br /> ___._Distance from foundation--------------------Distance to nearest lot line_-_._=___________ <br /> ❑ Number of pits---------- ......Lining material-----------------------Size: Diameter-----------------------Depth.--.-------------------------_- <br /> Ce spool: Distance from nearest well--------------___Distance from foundation--------------------Lining material ____....--------__._____.___________- <br /> ❑ Size: Diameter--- ----------------------------------Depth-------------------------- --- ---- ----------------Liquid Capacity---------------------------•gals. <br /> Pri y: Distance from nearest well----------------------------------------.--------Distance from nearest building-----------------------------------------. , <br /> ❑ Distance to nearest lot line___________________________ <br /> Rmod mg and/or repairing -------------------------------------------•••--------------------------------------•---•------------------------ 7 <br /> A ------------------------------ --------------------------------------------------------•-----------------------------•--•--•-------------------------------------------------------------------------------------------- <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, S ate .law , and r les and regulations of the San Joaquin Local Health District. 4 <br />' (Signed, <br /> Owner and/or---------------�--:.---:. ..---------='---------- -----------------• - ---------- ----------------------------------------------------------------------( / r Contractor) <br /> B -- Tale <br />,I (Plot plan, showing size o#-lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). _ <br /> FOR DEPARTMENT USE ONLY <br /> 3 <br /> t. BUFL'DING <br /> PPLICATION ACCEPTED BY_ - DATE_._. --•--- <br /> EVIEWEDBY. - --------------- ---------------------------------- ------------------------------•--- DATE--- ' <br /> PERMIT ISSUED------------------------------- --------------------- ----._ DATE------- ------------------------------------lterations and/or recommendations:------------------ ---------------------------------------------- -•-•-----•--------------------------••-Re a-------• '... <br /> ------------------- - ------------ ----------------- ----•-•----------------------•-------------------•------.._..---------------- <br /> - -------------------------------------- - ------------------- ------ ---- <br /> -------------• - ------- <br /> --- - --------------------------------------------- - - - - <br /> .- ------------------- _. ---- - ----------- •-•--------------------•• --------- <br /> f <br /> FINAL INSPECTION BY---------------- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 9 <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> - E13---9-2M iasaas ATwngo 13-s4 <br />