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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des ib <br /> This application is made in compliance with County Ordinance No, 549. <br /> JOB ADDRESS AND LOCATION--.._ ;;?- ----------- --- xo,�e 0 <br /> ��'01;�;�- -- 4 ---- ------------- <br /> al <br /> ot <br /> Owner's Name.,�,------- - ------- - ------------ Phone---,----------- --------------- <br /> -- -- ---- ----- <br /> ----------------- ---- - ------------------------------ ------ <br /> ------------------------------­­­­---------------------------------------------------------- <br /> Adc1ress,,-­­*!W-----Y---------jl?.0-X--17d-- ---------------- <br /> Contractor's Name--- ----------- ------------------------------------------------------------------------------------------------------------ Phone----------------------------------- <br /> Installation will serve: Resid nce Apartment House [] Commercial E] Trailer Court [I I Motel El Other El <br /> Number of living units. Number of bedrooms L___ Number of baths 1_-____ Lot size <br /> Wafer Supply: Public system El Community system 0 Private X Depth to Water Tabl.*-O- it. <br /> Character of soil to a depth of 3 feet: Sand E]-Gravel E] _Sandy Loom N Clay Loam E] Clay (] Adobe[j Hardpan C] <br /> Previous Application Made: Yes Ej No DR New Construction: Yes E'] No f2 FHA/VA; Yes E] No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: rN <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well________________Distance from founda'tion--------------------Material <br /> RNo. of compartments-----t-------------------Size------------------------------Liquid depth---?------------ ---------Capacity---------------------- <br /> Disposal Field- Distance from nearest well-14?--------Distance from foundation-A/A---------Distance to nearest lot line--X-------- <br /> tA Number of lines-_______I___!_____ ----- Length of each line.7-4-7-------------------Width of french--Sj�-�-------------------------- <br /> Type of filter material Depth of filter material----/-j------------Total 'length---0- -------------------------------- <br /> Seepage Pit: Distance to near we ----D11stance from foundation------­-----------Distance to nearest lot line---------------- <br /> 0 Number of pits----------------------Lining'material-----------------------Size: Diameter---------.-------.-----Depth-------------------------------- <br /> Cesspool: <br /> epth--------------------------------- <br /> Cesspool: Distance from nearest well----------I------Disfance-from foundation--- ----------------Lining material______._.____--------.___.________. <br /> ❑ <br /> aterial------------------------------------- <br /> El Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well_________________'F------------------------------Distance from nearest building____..._------_-_______________-____-----I <br /> ❑ Distance to nearest lot line---------------r <br /> Remodeling and/or repairing (describe)___________________--__-__ I----------------------------------------- -------------- <br /> --------------------------­---------------------------------------------------------- ------------------------------------------------------------------------------------------------------------I------------------------ <br /> ----------------------------------------I----------------------------------------­---------------------------------------------­----------------------------------------------------I------------------------------------ <br /> ------------------------------------------------------•------------------------------------•--•---f 1\ <br /> ------------------------- <br /> -------------------------------------------------------------------------------------------------------- <br /> a the work I hereby certify that I have prepared this application'andat the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and rules and regulations of the San quip Local Health District. <br /> (Signed)-- ----f - ------ ------ ---- --- ---- --- --------- ---------------------------------------------------(Owner and/or Contractor) <br /> ------- ------ <br /> By:-------------------------�;--------- ---------- -------- ---------------------------------------------(Title)-------------------------------------------------- ------------- <br /> ------------ <br /> (Plot plan, showing size-of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- <br /> -------------------------------- DATE-Pllll�------0-71�7 - <br /> - - <br /> REVIEWEDBY--- --------------------------------------------------------------I----------------------------------------------------------- DATE---------------------------------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------- ------------ ------- -------------------------------------- DATE------ <br /> Alterationsand/or recommendations:---------- --------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------- --------------------------------------1-r-------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------I------------------------------------------ ----------------------------------------------------------- ------------------------------------ ----------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- <br /> ------------------------------------------------------------- <br /> �01--------------------------------------------------------------------------------------I-----------------------------------------------------I--------------- <br /> FINAL INSPECTION BYIA044-1,40'-Iel� -------------------------- Date---- ..._ . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Rev;sea 1-57 FrP.CO' <br />