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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> prricafion is hereby made to the San Joaquin Local Health District for a permit to construct and <br /> install the work herein described. <br /> ,C <br /> This application is made in compliance with County Ordinance 4 No. 549 <br /> ----------- <br /> E LOCAT 0 ------ - ------ / . I— <br /> JOB ADDRESS A --------I ---- ----------------------------- <br /> 6 Phone-4- <br /> Owner's Name__ L ----- ------------ ------- ------ <br /> - ---------------------- <br /> --- <br /> Address... ----- --- --- - ------ ----- ----------------------------- - <br /> ------------------•-------- ----------------------- <br /> Contractor's <br /> ----------------------Contractor s Name--- - Phone----------------------------------- <br /> Installation will serve. Residence [Apartment House El Commercial [I Trailer Court [] Mofe,1 0 Other F] <br /> -V e i <br /> 'Umber of bedrooms Number o baths ---I--- Lot size --- ------------------------------ <br /> Number of living units: - <br /> Water Supply: Public S, /Community system [-] Priva+4� ;4epth to Water Table -------- ft. <br /> Character of soil to.a depth of 3 feet-.. Sand Gravel El Sandy Lo Clay Loam El Clay C1 Adobe 01_�Ilclpan C] <br /> ;�Ot �PN 0 F] <br /> Previous Application Made: Yes E] No New Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted .if public sewer is available within 200 feet.), <br /> --------------- <br /> aterial-_-le��--------- <br /> Ca <br /> SepVank: Dista from nearest welZO....L D ce, fro <br /> t Siet---- W.Liquid depth----------6---------- pacify of I <br /> No. compartments__--------------Z--- <br /> /0- -Distance to n <br /> Distance from nearest well-____ .0---Distance from foundation____-50 , Widt Pares, ------------ <br /> DlisposayFie�cl: Dish of trench---- --- r------------------ <br /> Number of lines-------------/ ------1--4-Lengfh of each line-------------- <br /> i4 Material------ ....Tofa-I length---------V,0----------------------- <br /> Type of filter mate ------M--------Depth of filter <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation--- ----------Distance to nearest lot line------------------ <br /> -Number of pits ,----Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- <br /> ------------------ <br /> El <br /> Cesspool: Distance from�-nea�rest well_________________Distance from foundation_____. Lining material-------------------------------------- <br /> "I ------Liquid Capacity----•---------------------- - <br /> ❑ Size: Diameter--------------------------------------Depth-------------!---------------------------- <br /> Privy: Distance- from nearest ---- <br /> well------------------------ <br /> ------------------------Distance from nearest building------------------------------------------ ;Wo <br /> ❑ Distance to nearest lot line---------------------------- ---------- ----- - <br /> ------------------------------------------ ---------------------------------------- <br /> --------------------------- ------- <br /> Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------- -- -------------------------------------------------------------------- ---------- <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 la4s, and rules ancd/jr gulations of the San Joaquin Local Health District. and/or Contracter , <br /> -----(Owner <br /> (Signed)......... <br /> -- --- ---------- <br /> By:------------- ----------------------------------- --------------------------------------------------------------------------------(Title)-------------I-------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side)- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY(-1�----------------------------------- ------------------------------------------------------- DATE-- <br /> ----- <br /> REVIEWED BY ---------- <br /> DATE---- -I- <br /> --------------------------------------------- <br /> BUILDING PERMIT ISSUED-------------------------- ----------------------------- <br /> ------------- DATE------------Ie------------------------------------------- <br /> Alferafi a /or r commendations: ----------------------------------------------------------------------- —--------- <br /> k -!- - ------- --- _r ;.:::t---------- -- ---- <br /> 0------------------- <br /> -------------- ------- <br /> --------- --- <br /> ------ ----- ---- ------ <br /> N_ <br /> ---------- <br /> r -------- <br /> -------------- <br /> --- ----- ------------ <br /> ------ ----- --- <br /> ------------- <br /> io <br /> ---- -- ---------- <br /> ---- - -------- ----------------------------------------------------- <br /> FINAL INSPECTION Date-- --------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street <br /> TracCalifornia <br /> Stockton, California Lodi, California Manteca, California y, <br /> ES-9-2M 8-51 Revised W-2100 <br />