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APPLICATION FOR SANITATION PERMIT Permit No- -. ..... .......... <br /> (Complete in Duplicate) / T <br /> Date issued ..... ........�.-53 <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. 549. L S'TdNZ- <br /> JOS ADDRESS AND LOCATION.... S ' <br /> . <br /> Owner's Name--------------------------- =----2)---t------------m----------- <br /> -- ---------------- ---- -- -- . Phone----•------------- •--------------- <br /> Address-------------------------------- 9 C-ti_e,.—c7 lG,�c <br /> •-- ------------.. <br /> Contractor's Name---------------------------------------------------- 11 --------------------------------------I•-------------------•--- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House E]., Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units. _1-- Number of bedrooms .-�0- Number of baths .�. Lot size --------- -------------- <br /> Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table l0--ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑. Sandy Loam ❑ Clay Loam ❑ Clay Adobe Hardpan E]Previous Application Made: Yes E] No E] New Construction: Yes ❑ No ❑ U <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 y <br /> t <br /> (No septic tank o`' cesspool permitted if lic r is available within 200 feet.) <br /> ..�_ <br /> Septic Tank: Distance from nearest well-............ stance// fro/m� foundaton__. _...._.__p/Ia#erialti..... '._..__--- <br /> .---- <br /> _... <br /> X. No. of compartments ---------------------Si�e. .T (`Z��`�_.`Liquid depth.... .�� 1L .G.---� <br /> Disposal Fie}d:, Distance.from'nearesf well O....._Distance from foundation__`/ .._-.-.Distance to nearest lot liinnee._..� .....4 <br /> 1. Number o-i lines................... Length of�each line--- _. r Width of trench____............ . .. Q <br /> Type of filter material-- / -j'! 1—..Depth offilter material.........fd.-._�__-Total length__-- _.--.2--...... <br /> Seepage Pit- ' Distance to nearest well----------------------Distance from foundation---.__._.°---------Distance to nearest lot line----.------------ <br /> ❑ Number=of.pits.------.--+.___---.-.Lining material----+---�L-----------Size: Diameter,=-1------ ----------Dept h-..-------------.---------------- <br /> } k - ] <br /> Cesspool: Distance from nearest well_________________Distance from foundation-_-_------......__y Lining material.. ------..._....._...._ ._ <br /> ❑ Size: Diameter----------`----4--------- ----- ----Depth----------•---------------------------}------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance 4om nearest building---------------------------------.----_.-. <br /> ❑ Distance to nearest lot line------------------------- --- ------------------------------------------=--------------- ------------------------- -------------------- <br /> d <br /> Remodeling and/or repairing (describe)-------------------------- <br /> t <br /> -------------------- --- <br /> % . `IV a <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 la s, and rulesegulations of the an Joaquin Local Health District. <br /> oma''� ,,• <br /> (Signed] # - -------------- ------------- {Owner and/or Contractor] <br /> BY=-------------------------------------------------.----------------------------------------------------------------------------------(Title)--------------------------------------------- - ------ -------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- -----•------- --- ----- ----- --------------I- ---------------------------------------- DATE-----------•- - - ----Q <br /> REVIEWED BY.----------------------- - ----------------------------------- DATE_--•----------� - �' r� ----------- <br /> -------------- <br /> BUILDINGPERMIT ISSUED------------------------ ----------------------------------•---------------------------------------- DATE------------------------- <br /> Alterationsand/or recommendations------------------------------ - --------------------------•-------------------- ----------------------------------------------------------------------------- <br /> -------------------------t-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------•-----------------t-------------------------•----------------------------------------------------------------------------------------•----•-------------------------------------••---------------------------------- <br /> ----------I----------------------- -------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----•--------------------------------------------------------------------------------------- --------------------------•---------------------------------------------------------------------------•----•------------------- <br /> FINAL INSPECTION BY:.---- ----- --------�1 �- --------------------- Date-------------------- - ------ --.�`.�.....' <br /> SAN JOAQUIN 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 10-52 Revised W-2100 <br />