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APPLICATION FOR SANITATION PERMIT Permit No. <br /> - ------------- <br /> [complete in Duplicate) Date Issued <br /> pplicafion is hereby made to the San Joaquin Local Health District for a permit toconstruct and insto wqrk erein �e ribe <br /> us application is made in compliance witCqunty Ordinance No. 549 <br /> X <br /> JOB ADDRESS AND LOQATIQN--- ------- - --------W---- <br /> Owner's Name ---------- --- ------ -- -----/---- -------- Phone_ ---- ------ <br /> Address-6a ---------- Phone- R, <br /> Z-- ----------------------------------------------- ----- ---------- ---------- <br /> 7 <br /> Contractor's Name----------------------------------------------------- ------ <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court El Motel. Other El <br /> Number of living units: Number of bedrooms __.r-- Number of baths I--- Lot size ......7--- 11 -__ --------------------- <br /> Water Supply: Public system E] Community system El Privateg Depth to Water Table//Wlft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam E] Clay Loam 0 Clay E] Adob ek Hardpan E] <br /> Previous Application Made: Yes 0 Nox New Construction: YesX No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest ---Distance from <br /> / foundation- <br /> --e Ma#grial______._____-__ <br /> Capacity <br /> --------- Liquid -No, of corpartmerfs-_._- ------- Sile.4 _ <br /> Disposal Field: Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line_--._________.___ <br /> ❑ <br /> ine----------------- <br /> F1 Number of lines-----------------------------------Length of each line------------------------------Width of french.---------------------------------- <br /> Type of filter material-------------------------Depth of filter material O_Total length___._________-_______--------------------- <br /> ----------- <br /> Seepage Pit: Distance to nearestfromAundation -- ---- Dist �,e to nearest lot line___-__.__ <br /> well----- -- --------Distance <br /> Number of pits------/--------------Lining materia;e Dia efe .... --------Depth <br /> A vv_Z_fA------- Z <br /> r"esspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.,_____________.___.____.__._____ <br /> Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: <br /> apacity----------------------------g ls- <br /> Privy; Distance from nearest well------------------------------------------- Distance rom nearesi building--------------------------------------.--. <br /> ] <br /> uilding------------- --------------------------- <br /> ,e s, 'vel----------- ------- ----------- --- ---- -Distance ro, <br /> 'n Distance to nearest lot line----------------------------------- -- --------------- - --------------- --------------------------- ------------------------------ <br /> -- --- -- -- --- ----------- <br /> Remo#ling and/or repairing (describe):-. - -- ----------------- --- - -- - -- ----------/------ --------- <br /> - <br /> -------- <br /> ...... ........ <br /> --------------------------- ------ --------------------- --------------------------------- <br /> - --------------------------------- --------------- <br /> ----------- -------------------------------•----------------- --------- ------------ ------------ ------------------------------------------------------------------------ <br /> ----------------------------------------------------------------------------------- ----------- ----------- -------------- <br /> 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, State,-". a and r tions of the San Joaquin Local Health District. <br /> 5�n ----------- ------------------------------------------ wn d/or Contractor) <br /> ----- - --------- a (3/0 T _T <br /> (Signed)---------- ----- -- ---------- ----- -- ----------- (0 a <br /> By:--------7-------_ 1. e -----------------------------------(Title) <br /> --------­-------------------------------4_ --If/ ----------------------- <br /> V. n re arse de].(Plot plan, showing size of lot, location of system In relation to wells, buildings, etc., can be placed o <br /> ---- FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------------------ ---- ---- ---- -------- ------------------------------------------ ---- DATE------ ------ - - .5-1-------------------------------- - <br /> REVIEWEDBY--------------------------------------------- ----­- ­ ------------- ------------------------------------- DA E------ -0--=- -------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------- ---------- - --------- -------- -- ------------ ------ D ----- ------ --------- ------------ ------- <br /> --- --- ------ -- ----- - ----- <br /> Alt tions and/or recommendations: ---- ---- <br /> ---------------­------------- ---------- <br /> --- --------- --- ------------------ ------------ ---------r--- ----------- ------ -------- ----------------- ---------------------------- <br /> ---- ------ ----------------- <br /> --- 1---- --- ------ ------ - <br /> ----------------------------- <br /> ------ - ---- -- --- - ----- --- -------------�V_ -- ---- --- --- ------ <br /> 17 . .........., <br /> FINALINSPECTI ----- - ------- --------------------- Date-- 6 ------------------------------------------- <br /> SAN JOA IN 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 /> E5-9-2M 10-52 Revised W-2100 <br />