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APPLICATION FOR SANITATION PERMIT Permit No. _33/-L_-_______ <br /> (Complete in Duplicate) S"Y <br /> Date Issued <br /> � 1 <br /> Application is hereby made to the San Joaquin Locaf Health District for a permit to construct and install the work herein cribed. <br /> This ap lication ismade in compliance with County Ordinance No. 549. <br /> f Qxe <br /> �j `'� (�iDDRESS ND LCATON---L_U " r�----- -- -------( -F----- b 1� e��-------- <br /> JOB-, <br /> Owner's Name------- _t - I-- ( 1 tr ------ Phone------------------------------------ <br /> _7 <br /> F x NAV o o 4 � i� 1 S r, ---------------- <br /> Contractor's Name-----— _:!f! __ _•_____________-__ (j <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _7-Number of bedrooms -5- Number of baths _ "Lot size _____d_ __ -•--- ___________________ <br />�- Water Supply: Public system [] Comm unity,.system :❑ Private Depth to-Water Table ____ _ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam lay Loam E] Clay ❑ Adobe E] Hardpan ❑ f <br /> Previous Application Made: Yes E] No New Construction: Yes Uo ❑ <br /> f TYPE OF INSTALLATION AND SPECIFICATIONS: ; <br /> (No septic tank or cesspool permitted if pujjb��lic sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-___. i._~�___Distance from foundation- -`_-.Material - --n--v ___r__ <br /> ------------- - <br /> No. of compartmenhs----_---`---------------Size_�.�-.,��--�----------Liquid depth,-----,�--.-'----.--Capacity----1�-�- <br /> e <br /> Disp^osaIl Field: Distance from Weare t welL__ ___.Distance from foundation__-__ ✓_____.Distance to nearest lot line___y____________ <br /> L ' Number of lines____7__�,p� !�'"a j ._.Width of trench________�__'__�________________ <br /> _ip�-�-�-------f�---Length of each line-- ---�-------- /f f <br /> Type of filter material_ �1�_ �_______-Depth of filter material__ __� ______Total length <br /> ______________f_ ____-____.____ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-__._______________.Distance to nearest lot line----------------- <br /> 0 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth-------------------------------- <br /> Cesspool: Distance from nearest well-----_-----------Distance from foundation_______________.___Lining material-------------------.___-______-______- <br /> [] Size: Diameter------------------------------------Depth--------------------- -----------------------------Liquid Capacity----------------------------ga <br /> Privy: Distance from nearest from nearest building-------_ . ____.__________.______-______. <br /> ❑ Distance to nearest lot line---------------------- ------------------------------------------------------------------------------------------------------ ---------- -- <br /> Remodelingand/or repairing (describe):------------------------ ----------------------------------------------------------- --------------•- ------------------------------------------------ <br /> ------------ ---- - <br /> ----------------------------- <br /> --- ` -----------��_ _ ........... - ------------------------------% 1� --- <br /> ----- ----- ------ <br /> t <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed). -� - - --- ----- ----- ---ft ----------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> ----------------_-• -----------------------(Title)--------------------------------------------------------------- <br /> (Plot plan. showing ot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). <br /> �- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--- -------- --------t------------------------------------------------------------- DATE-------- ---------------- -- --._. <br /> REVIEWED BY DATE ll� ~I" `r ' <br /> ---- ------- ------------- -------- -------------- <br /> BUILDINGPERMIT ISSUED-- ------:---------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommondations------------------------------------------------------------------------------------------------------------ ------------------------------ --------- <br /> ----------------------------------••-----------------------------------------------------------------------------------------------------------------------•--------------------------------------•-------•------__------ <br /> ------------------- <br /> ------------------------------------------------ ------------------------------------ -------------------------------------------------------•---•-------------------------------•-- <br /> ------------------- - = - -/ _____:__::::________..___ <br /> FINALINSPECTION B - ------------ ---------------- -- - ---- D --- --------- --------------------------------------------------------- ---- <br /> SAN JOAQUIN LOCAL HEALTH +[STRICT - w <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Sfockfon, California Lodi, 6'17fornia Manteca, California Tracy, California <br /> ES-9-2M B-51 Revised W-2100 <br />