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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Applica-1-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei)described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN� LOCATION ew ----V----------e_ <br /> Owner's Name- - - -------------- <br /> ---lu <br /> --- ------- ---- -------------- ----- ------------------------------------- Phone------------- <br /> �4, � ----------------------- <br /> Address --- .. . ....2 <br /> Contractor's Name <br /> ---- ----------- ------------ Phone---------------------- ----- <br /> Installation will serve: Residence El Apartment House E] Commercial El Trailer Court El Motel E] Other <br /> Number of living units: -------Number of bedroomr-r.r- Number of baths size ----- .... <br /> Water Supply: Public system E] Community system E] Private X Depth to Wafer Table 1_�� <br /> Character of soil to a depth of 3 feet: Sand F] Gravel Ej Sandy Loam E] Clay Loam E] Clay <br /> Adobe Hardpan E] <br /> Previous Application Made: Yes E] No YN New Construction: Yes x No E] )� E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pubr1j* sever is available within 200 feet.) <br /> Septic.Tank: Distance from nearest well--],l _0 Distan from�p <br /> _.S. __ycl tion----/P--------Materia <br /> ---------------------- -------- <br /> No. of compartments-.-A--- --- ---Liquid clep�fh__ <br /> ------ ----- -Capacity--/- ------------- <br /> Disposal Field: Distance from nearest we4l�v-/)!Distarce 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 Nit. Distance to nearest well----------------------Distance from foundation-------..----__-_-- Distance to nearest lot line----------------- <br /> F1 . Number of pits----------------------Lining material--------------------...Size: Diameter--.-----------------.__Depth-..----------------------------_ <br /> Cesspool <br /> epth-.. ----------------------------Cesspool- Distance from nearest well-----------------Distance from foundation...... . . ------ Lining material--------------___-------.------------. f <br /> ❑ <br /> aterial-------------------------------------- <br /> 1­1 Size: Diameter-------------------------- - ---------Depth---------------------------------- ----------------Liquid Capacity- -------------;w--- ---gals.. <br /> Privy: Distance from nearest well-_ -,--------------------------- -- - ---------Distance from nearest building--------_---_--___------_-_Distance to nearest lot fine_ <br /> ------------------------------- _0------ <br /> Remodeling and/or repairing (describe):---------�Z& <br /> ----------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------- ------ - ------------ <br /> 0­111��--------------- <br /> ------------------------------------------------------------------------------------------------------------- ------------------------------ ---------------------------I------------- -----------------------------------------------1-----------------------------------------------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, ate laws, and rules and regulatiorls of the San Joaquin Local Health District. <br /> ),_VM AU-4-1-- -4- ( 1 1 <br /> (Signed)-- - ------- _ --,-- - - I <br /> -- ------------------------------------------------­---------------- ------(Owner and/or Contractor) <br /> r. <br /> By:------------ ---------- -- ------------------------------------------------ -_-_—----------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- --------------------- --- ----------- ----------------- --------------------------­ ----------- DATE------------ <br /> REVIEWED BY--------------------------------------------- -- <br /> ------------------ ----- ------------­ ----------- DATE----- - !r_ ,.i <br /> BUILDING <br /> ATE------ <br /> BUILDING PERMIT ISSUED-------------------- -------------- DATE------ - -------------- <br /> Alterations and/or recommendations:------------------------------------- ------------------------------------------------------------ <br /> ----­------------------------------- <br /> -----------------­­-------------------------------------------------- -­----------------- ------------------ --------------- _-------•-•------• ­ <br /> ----- ------- <br /> -----------------------------------------------------I----------------------------------------------------------------------------------- ------------------------ <br /> -•---•--------------- <br /> ----------------------------I---------------- ------------------------- --- ---------------------- --------------•------------------------- ------------------- ----------------------------- <br /> -------------- ---------------------------- <br /> ------------------- --------------------------- --------- <br /> FINAL INSPECTION BY:--------------- - Date ------------ --------------------------------------------- <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9 145446 A7WOQD <br />