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t APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete in Duplicate) Date Issued <br /> install the work herein described. <br /> Application is hereby made to the Son Joaquin Local Health Dist rict for,a permit to construct and nd <br /> This application is mallein compliance with County Ordinance No. 549. <br /> -------- ---- <br /> JOB ADDRESS AND ATIO -------- - -------------- •- ---- ---- -- - ------------—-- ----------------------- <br /> Owner's Name------- - - - --------------------- -------------------------------------Phone------*7-- --o-lid-77 <br /> ------------------- <br /> Address-- -------------_ ------ --- ------ ----------------------- <br /> "0' <br /> ----------------- Phone--,? <br /> Contractors Name--.-.---14, ------------ Other 0 <br /> Installation will serve: Residence Apartment House 0 Commercial .-E] Trailer Court <br /> ❑ MoteleyLl o--------------- <br /> Number of living units: __1... Nurnbe,�'of bedrooms_ Number of baths -,/--- Lot size " <br /> y' ern C3 Community system 0 Private Water Supply: 0,Public s S.tDepth to Water Table ­5'ft. <br /> Clay Loa Clay ❑ Adobe❑ Hardpan E] <br /> Character of soil to a depth of 3 feet:- Sand El Gravel [I Sandy oam. [] M. <br /> P revYes E] N; <br /> ious Application Made: Yes El. No, New Construction: <br /> 1101 <br /> TYPE OF INSTALLATION AND. SPECIFICATIONS: %r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-_ ______________Distance from founclaf ion--------------------Material------------------------------------- -----------�j <br /> No. of compartments---------- --------- Size------------- Liquid depth--------------------------Capacity--------------- <br /> Fi Distance from nearest Distance from foundafion__/4---!----.-.Distance to nearest lot line___,-______-Disposal <br /> P/ ......I---------- <br /> -1r. lines--------/----- --------Length of each line------ of trench._____o-c------ <br /> Number o ----------- 130 <br /> Type of fit material-------------------------Depth of filter material----------------------Total length----------------------------------------- <br /> Pit: Distance to nearest well-.--------------------Distance from foundation--------------------Distance to nearest lot line_____--.______-__ <br /> Seepag I e Number its. --------Depth---------------------------------- <br /> F, umer op ------- ---- --------Lining material-------------- ------- Size: Diameter--------- <br /> Cesspool. Distance from nearest-well-----------------Distance from foundation._--____________-- Lining material____-________________-______------- <br /> ❑ 1 0. . ' --------- -----------Liquid Capacity <br /> Siz6- Diameter---------------------------- ---------Depth-------------------------- ---- ------------------ ---------g al-- <br /> l s <br /> I I <br /> Privy- Distance from nearest well---------------------- ------------ -------------Distance from nearest building------------------------------------- - -- <br /> .......................... <br /> Distance to nearest'lot line-------------------------- ------ ------------ ------------------------ ------------------------ <br /> ' ----------------------- .................. <br /> Remodeling and/or repairing [describe)------------------------ --d----- <br /> -------------------------------------------------------------------------- <br /> ----------------------------------------------------- ............------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------------------------------------------------------------------------------------- -----------------------I------------------------------------------------- <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 /> I ions of the'-San Joaquin Local Health District. <br /> ordinances, S+��aws,.-and rue and regu u nii, (OwnTAan or Contractor) <br /> (Signed) <br /> -------------------------------i--------------------- <br /> By:." 4 ------- ----------------------------(Title <br /> -4 <br /> (Plot plan, showing size o _er <br /> f, lo'ation of system in relation to Wells, buildings, etc., can be <br /> ed on reverse sid <br /> Dfo; c <br /> FOR•DEPARTMENT USIf ONLY <br /> APPLICATION ACCEPTED BY------------------------------- ----------- DATE---------- - -- --------- - - <br /> _?R�w——----------------------------- ------ <br /> DATE---------- -----­--------------- ------­------------ <br /> REVIEWEDBY---------------------------------------------:----------------V-------------------- ------------------------ F� <br /> BUILDING PERMIT ISSUED------------------------- - - ---------- DATE ---------------------------------- <br /> Alterations and/or recommendations-------------------------- -------------- --------------------------------------------------------------------------------------------------- -------------- <br /> I - ----------------------------------------------I---------------------------------- <br /> ------------------------------------------------------------------------------------------------------------- <br /> ------------------------- <br /> ------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------- ----------------------------------------------------------------------- <br /> i ­------------­------- ----------------------------------------------------------------------------------------- -------------------- <br /> --------------------------------------------------------- ------------------------ -------------- ---------------- -------------------------0--------- <br /> ---------------------- ---------------------------------------------- <br /> - ------------------------------------------- ---------------------------------------- <br /> --- --------__ ---------------------------- <br /> FINAL INSPECTION BY:- Date-- Y . . 5... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i3o South American Street no West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, CaliforManteca, California Tracy, California <br /> -mia' Lod;, California <br /> ES�9_-2M 10-52 Revised W-2100 <br />