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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued / / <br /> Applica-%n is hereby made to the San Joaquin Local Health District for a permit to construct and install a work herein described. <br /> This application is made in compliance ' h unty Ordinance No. 549. <br /> �pl Ordinance No. 14 <br /> e h u ty <br /> C _ __ I <br /> JOB ADDRESS AND TION____-- -- ------ ------ <br /> s Nam <br /> ....... Phone-- <br /> Address---- <br /> . . . ........ - --------------------- n <br /> Owner's Nam -------- - - ------------- - - -- ------------------- ------- ------ ----------------------- ho e__ <br /> Address- ............ <br /> Contractors Name... ------------------------------------------------------- Phone----;'X:�/ <br /> --------------- --- <br /> Installation will serve: Residencey Apart Commercial 0 Trailer Court [:] Motet [:1 Other E] <br /> Number of living units: -Number of bedrooms --t---- Number of baths __/--- Lot size <br /> x --------------------- <br /> Water Supply: Public system F-1 Community system 0 Private X_Depth to Water Table,44Vft. <br /> Character of soil to a depth of 3 feet: Sand [3 Gravel E] Sandy Loam E] Clay Loam 0 Clay 0 Ado' "K4 Hardpan El <br /> Previous Application Made: Yes F] N6VI New Construction: Yes ru"' No F <br /> TYPE OF INSTALLATION AND SPECIFIC TIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__- Distance from foundatir---14----------Ma erial--- --- <br /> f)L///__Liquid clep�h__� <br /> No. of compartments—Z.----------- ----Si"47x---I Capacity------------------------ <br /> nearest 1 e <br /> If <br /> Number of lines-------I------------- ---Length of each line---------�6a------------Width of trench-_----------- .... <br /> .;4 <br /> Disposal Field: Distance from nearest we4_�� Distance from foundation_/,2- Distance to 4..... <br /> X <br /> It-------- ------------ <br /> Type of filter material --- Depth of filter material--.IS---- Total length__________ ---------------- <br /> Seepage Pit; Distance to nearest wefi----------------------Distance from foundation----------_--------Distance to nearest lot line.__________-___-. <br /> ❑ <br /> ine----------------- <br /> 0 Number of pits----------------------Lining material-----------_----------.Size: Diameter-----------------------Depth------------------------.--- _- <br /> Cesspool: <br /> epth----------------------------- -- <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 bAding----------------------------------------- <br /> El Distance to nearest lot lire_ <br /> Remodeling and/or repairing (describe) ----------------------------------------------------------------------------------------------------------------- <br /> -------------­­­-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------•------------11------------------------------------------ --------•----­-------------------------------------------I--------------------------------------------------------------- <br /> -------------------------------------------------------------------------I------------------------------------------------- -----------------------------------------------------• ---------------- ------------------- <br /> I hereby certify that I have prepared this pplicaf n and that f war ill be e in accordance with San Joaquin County <br /> flat <br /> ordinances, Staf s, an le and re I sof n Jeoaquif.. oca ealth ricf. <br /> (Signed}__________ - <br /> -- ----- ---- --- ---------- --S-40winer and/or Contractor) <br /> low OW <br /> By:------------------ -------------- --------------------------------------------------------------(Title)------- <br /> ----------------- ---------------- <br /> ---- ----- --- . ...... <br /> (Plot plan, showing size of lot. 10 n o sy em in relation to wells, buildings, efc., can be plac on re4rs, side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - _ <br /> -_-.--------------------- ----- - -------------------------------------------- ------------ DATE ------------I---- ------------- <br /> --------------------- <br /> REVIEWEDBY------------------------------- !_�-------------------- --------- -------------------------------------------- DATE___:�I. <br /> kK-----------­­---------------------------------- <br /> BUILDING PERMIT-ISSUED---------------------------------- -------------------------------------------------- ------ --------- DATE-------per <br /> Alferafrons.and/or recommendations:-------------- --------------- ------- -- ----------------------------------------------------- ------------------------------ <br /> --------------------------------- <br /> ------------------- ---------•---------------------------•--•--•----------- ---------------------------------------------------------------- ------------------------------------------------------------------------------ <br /> ---------------- --------------------------------------1-1-------- -------------------------------I------ ------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------- --------------------------------------------------- --------------------------------------------------------------I------ -------------------_--------------------------- ------- <br /> ------------ <br /> ----------------------------------------�e�----------------------------------------------------------------------------------------------------------- ----------------------------------­_*-------- <br /> FINAL INSPECTION --------------------------------------- Date_ <br /> - ----------------------------------------------- <br /> SAN JOAQUhN 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 /> ES-9-2M Revised W-2100 <br />