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V / <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. .f!..1.�_.___ <br /> / (Complete in Duplicate) <br /> Date issued ___.3 <br /> IM-_S-,2 <br /> Applica+ion 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. 49. <br /> JOB ADDRESS AND LOCATION_------ ---- ---�- <br /> Owner's Name... .. --------- <br /> --- ---------------- <br /> Address--------A!w <br /> --------------Address--------A!w '-------- u- -.-_.._..� ..----•---.._.. .. . �- - - -••---------------------------- <br /> Contractor's Name------------•_-• _-- <br /> Installation will serve: Residence.❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size <br /> .../ .. � <br /> ... .- -------------------- <br /> Water Supply: Public systemommunity system ❑ private ❑ Depth to Water Table `6.0_ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ElClay Loam ElClay E] Adobe R-_'Hardpan E]Previous Application Made: Yes E] No New Construction-. Yes [❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 4sptic <br /> Tank, Distance from nearest well--------------------Distance from foundation--------------------Material-------.--------------------------------.-------- <br /> No. of.compartments------- ----- .-----Size-------------------------------- Liquid depth-------------------------.Capacity----------------------- <br /> pos I F,i d: Distance from nearest well-----------------Distance from foundation---_----.------------Distance to nearest lot line_______-_.;_____. <br /> Number of lines-----------------------------------Length of each line----------.___------------:,_.Width of french----------------------------------- <br /> Type <br /> ---------------------------------- <br /> See a alit: Distance to nearest well_ __ - ._. Distance f om foundation___ -_Q Total length_________--------------------------------- <br /> Seepage <br /> ________________________________ <br /> T e or filter material-_------_- ---- .-_----Depth of filter material________________ <br /> p g ��-- I.___.Distan ce to nearest -•• e�__3.__r <br /> Number of pits...... Lining material--- r2.,_Size: Dia meter. ._. .__..____Depth__ ag - <br /> Cesspool: Distance from nearest well---------------___Distance from foundation____-- -------- material------------------------------------ <br /> ElSize: Diameter- --i-------------------------------Depth---------------------------------- ---------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----_---------_---------------------------------Distance from nearest building---------------------------------.-------- <br /> Distance <br /> ____-.Distance to nearest lot line---------------------------------------------------------------------------------- --------------------------------------------• <br /> ) <br /> Remodelingand/or repairing {descrise)!----- - ---------------------------------------------------------------•-----•-------------------=------•----------•----------•------------------------- : <br /> . \ e <br /> •--------•--------------•---••---------------------•------------#---------------------------- --------------------- -------1-------------------------- V <br /> i <br /> -------=----------------------------------•-------------------------••-----------------•-•---------•--------•---------•-------------------------•--•-•-------•---------- ------•------------•-------------------------------- <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, State IaW an rules andEregul91ions of a San Joaquin Local Health District. ' <br /> (Signed)-------- ! {Owner and/or Contractor) <br /> By: !-.......... � Tale 1 . <br /> -- - <br /> (Plot pian, showing size of lot, location of syst�a i 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------------------------------------ ----------- DATE- <br /> BUILDING PERMIT ISSUED---------------------------------- --�----'------------------------------------------------_-.-LDATE------------�` ` <br /> Alterations and/or recommendations:= -------------------------­--------------- -------•--• �--- -----------._..__..,_ <br /> ----- - ----- — ----------- -------------- --- ---------- <br /> --------- -------------- - ---------- <br /> --------- - - - - - ---------------------- ------ ... ---------- <br /> ------- - - <br /> ----------------------------------------------------- --------------------------- --------------------------------------------------------------- --------•--- --------------------------• -------------- <br /> FINAL INSPECTION BY-------------------- .--------- ------------- Date.-- ----- <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 I Lodi, California Manteca, California Tracy, California <br /> ES-9 145446 ATWOoa <br />