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APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete in Duplicate) %, <br /> Date Issued <br /> Applipatron""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. <br /> f <br /> JOB ADDRESS AND LOCATION----------- ------- ------ -------- --- ------ — <br /> --- ------ --------------------------------------- <br /> Owner's Name------------------ ------ ff/ <br /> _J <br /> -------------- ----- --- <br /> - --- - --------------------- Phone <br /> Address--------------------1 _ <br /> %n)------ ---- <br /> ---------------- -- --- ------- - - ----------7---------------------------7----------- <br /> Contractor's Name-------- --- ---- ----- ------- --- --- - - - --------- --- one..... . <br /> --------------- <br /> Installation will serve: Residence ;A <br /> 01 Apartment'rtment House Ej Commercial E] Trailer Court E] Motel [] Other El <br /> Number of living units: Number of bedrooms _-n-eNumber ofhafti-s— --- Lot size ------- <br /> Wafer Supply- Public system ❑ Community system E] Private [A-," <br /> Depth to Wafer Tablet.jzft. <br /> Character of soil to a depth of 3 feet.. Sand E] 07ravel E] Sandy Loam E] -06'yloam El Clay ❑ Adobe[�--_H�ardp.n ❑ <br /> N o F-I <br /> Previous Application Made: Yes E] No ©/New Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer isiiavailable within 200 feet.) <br /> Se t' T k<� Distance from nearest �l <br /> p 1� 9P w -7�' --Distance from fc ---/0--------Ma ial,__4 <br /> .?.undation <br /> ___V-------- <br /> r4l_� No. of compartments---1.2 --------Size--- <br /> ------- depth --------Capacity----- <br /> Disposal Field.- Disfance from nearest well-f Distance from founclation/442-------.-Distance to nearest lot i <br /> [A� -,,Length of each line---- �V__ <br /> Number of lines.----/ of trench--______ __I <br /> -ILe lot <br /> 5_�-------------------- <br /> Type of filter material Depth of filter material -Total length------- -------------------- <br /> Seepage Distance to nearest well____ Distance from fpun Afion_ -------DisfanceJ6 nearest lot line--- <br /> Number of pits------691�,_k-e---Lining material., <br /> ize. Diameter---- ------------Depth----A:5— ----------- <br /> Cesspool. Distance from nearest well-- ________ .__ Distance from foundation______ __ Lining.material___ <br /> ❑ <br /> Size: Diameter-------- ----------- ----------Depth---------------------------------------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well________________*_---____---__________--___Distance from nearest building--------------------------------------- <br /> ElDistance to nearest lot line------------------------------------------------------- -------------- -2 <br /> 4��-------------------------------------------- <br /> Remodeling and/or repairing (describe)__________________ --- --- <br /> - <br /> ----- -•--•-----------------•-------------•-----------------­-------------------------------•-----------•---------------•---------- ------•---------•----•--------•-------._....---------------­----------- <br /> --------------I----------------------­-­---­---------------- ----­---­------------ <br /> _-------------------­-----------------------------------------------------------------------_-------------­--------- <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 lawspnd rules and regulati ns ofhe San J a4in Local Health D-trict. <br /> A <br /> (Signed)--------------- ------- ­ q -d/or gni7r <br /> ------- ----- --e----- -- --------------------��Owner Ir! C -6actor) <br /> By:--- ------------------- <br /> ..... ............. <br /> ---`-------- ------- --------- --------------------------------------------------(Title)-------- ... ..I <br /> AIP ---------- -------------- ---- <br /> (Plot plan, showing size of lot, 10 i of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FQRDEPARTMENT USt NLY <br /> APPLICATION ACCEPTED BY----- _ _ <br /> REVIEWED BY-------------------------------- -- --------------------------------- <br /> ---- DATE--- ----------------- ------ I <br /> --------- --------- ------------------------ DATE------- - <br /> ---- ---- -- ---------------------------- DATE--------- ------------ <br /> BUILDING PERMIT ISSUED------------------------- - ----- ------------- -------------- Q TE---------------/ <br /> ---I----------------------------------------------------------- <br /> Alterations and/or recommendations-------------------------------------------- <br /> ------ -----------------------------------------I---------------------------------- <br /> -------------------------------------------------------------I----------I------------------------- - --------- ------ ------------ ------------------------------------------------------------------------ <br /> --------------------------------------------------------------- -------------------------------- --- --------------------------------- ---------I-------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------ --------1---- ------------------- ---------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY---------------------------------------------------------- --- Date_.--- ---- <br /> SAN JOAQUIN LOCAL LTH DISTRICT <br /> 130 South Arnorican Street 300 West Oat Street 132 Sycamore Street. 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-2M 8-5) Revised W-21oo <br />