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APPLICATION FOR SANITATION PERMIT <br /> Permit No.e�__ 1-- ----- <br /> (Complete in Duplicated Date Issued - --' ?-� <br /> Application 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. 544. <br /> JOB ADDRESS AND LOCATION -- ------•--�- - ' <br /> `! ---------------------- Phone <br /> Owner's Name---------------- --- -1--- -------------- ------------------ -- - - <br /> -- ----- ---------- - -- <br /> Address '-------------------------------------------------------------------------------------------------- <br /> -------------- <br /> -_ ---------`7�-------- --------- <br /> Phone <br /> Contractor's Name------------- � <br /> - -- •--- •--------••--�--------------------- <br /> Installation will serve: Residence ❑;`Apartment House ❑ ` Commercial ❑ Trailer Court ❑ Motel ®-Vther ❑ <br /> Number of living units: - -- Number of bedrooms---- Number of baths _ - Lot size -----._____________________________________________________ <br /> Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑. Sandy Loam ❑ Clay'Loam E+­e#ay❑ Adobe❑ Hardpan ❑NIII-A <br /> Previous Application Made: Yes ❑ No New Construction: Yes 8� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspoolpermitted if public sewer;is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---�4'imt_s-Distance from foundation___,/_U-�______Material_____ _4tl `z `------------------ <br /> Na. of compartments_________________ _ �..?�,,-_�-Liquid depth_-____— --.____----____Ca capacity <br /> �. -------------------------- <br /> -Distance <br /> P Y <br /> I <br /> Disposal Field: Distance from nearest well e; C, istance from foundation__-_)__t)_-_____--.Distance to nearest of�infert <br /> Number of lines---!____-__�' ---------Length of each line-____4--'0 ��j0___-Width of trench--------------=t--------------- <br /> Type <br /> _____-- ____.Type of filter material__. A_ _A -:.Depth of filter material___--_ -----------Total length------------ ---40_V------- <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 /> -NN <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---_---------------_Lining material__________-___________________._____. <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------- -------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------------------- <br /> ❑ Distance to nearest lot line------------------------------------- ---------------------------- ---------------------- i <br /> Remodeling and/or repairiPg (describ%ey ---------!/l�-�-------�`Jt'1'`- <br /> - <br /> ------------------------1------- <br /> ---------------------------------------------------- <br /> --------------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ---------------------------_-(Owner and/or Contractor) <br /> n relation to {Title) <br /> –� � <br /> ---------------------------------------------- <br /> (Plot plan, showing size of lot, location of system i wells, buildings, etc., can be placed on reverse side). <br /> I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------` - DATE 7 ---------------- <br /> a --------- <br /> REVIEWEDBY------------------------------------- - -------------------------------------------------- <br /> DATE <br /> - ----------------------------- DAT <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------- DATE <br /> ' -- ------- -------------------------------------------------------------------------------------- <br /> Afterations and/or recornnrcndations--------------------------------------'i--------- ----- <br /> --------------------------------- ----- <br /> ! -------------- --------------- <br /> t ------------------------------------------------- ----------------------------------------------- <br /> --------------------- ----------------------------------------- <br /> ------------ ;, <br /> r --------------------------- <br /> FINAL INSPECTION BY:-----------d' t Date------------- -,-- --- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Souf6 American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California <br /> Lodi, California '! Manteca, California Tracy, California <br /> ES-9-2M B-51 Revised W-2100 <br />