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APPLICATION FOR SANITATION PERMIT Permit No. .. <br /> (Complete in Duplicate) Date Issued <br /> Applica{ion is hereby made to the San Joaquin Local Health District for a permit fo constru tan install fih wo k h ein described. <br /> This application-is made in compliance with County Ordinance No. 549. �, �r I <br /> JOB ADDRESS AN ATION- `r =� "' �1.rr- ; <br /> Owner's Name--------- ---------- '�... --------------------- .---- Phone------------------------------------ " <br /> A .. <br /> Address--------------------•-- -------- ------ --•----------------- ------ - ------- <br /> - ----- <br /> Contractor's Name----�. 5 .- '�-- ---- {---- �7� 1 <br /> - - -- ------ Phone-- ------- - -- <br /> Installation will serve: Residence UKApartmen House ❑ Commercial E] Trailer Court L3Motel ❑ Other ❑ <br /> Number of living units: _-.P-- Number of bedrooms --'Number of baths __1--- Lot size ----.�--- -------------------------- <br /> Water Supply: Public system ❑ Community system ElPrivate Ea_,Pepth to Water Table .--------ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay E] Adobe�rdpan ❑ <br /> Previous Application Made: Yes ❑f No New Construction; Yes Ldt` "�o <br /> El <br /> , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if p blit sewer is available within 200 feet.)�� / <br /> 5e is T nk:� Distance from nearest wel --- Distance frim foundation_j-6-.-------Material_f�s-¢_ <br /> 3 <br /> No. of compartments.__'. .....---Size. --__- - .---Liquid depth. --------------Capacify_,/+l[�4���-� <br /> Disposal Field: Distance from nearest well�_-.--Dis{a-nc�trom bur ation---- �_---Distance to nearest lot lie.-..__-- .. <br /> r <br /> Number of lines:----� �_ /�-y-----'Length of each line-.- '-p- Zi 11 <br /> of trench-- ------ ------- --------------- , <br /> Type of filter maternal__-.-__V.-----_�.-..Depth of filter material---- --.4-_ ------Total length-------,1-- _Q--------------------- <br /> w ` - •• <br /> Seepage Pit: Distance to nearest well Distance from.foundation-------------------.Distance to nearest lot line--._----------.. <br /> ❑ Number of pits--- --------- --------Lining material-----------------------Size: Diameter------------------------Depth------.------.-----_----.-------- <br /> Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-------------__-----.----------------. <br /> ❑ Size: Diameter.k--------------- --------------------Depth---------------------------------- -----------------Liquid Capacity- -------------------------gals. <br /> Privy: Distance from nearest well-------------------:----.------------------------Distance from nearest build ing------------_.-.--------------.----_----. <br /> ❑ Distance to nearest lot line------------------ ------------------------------------------------------------ =- =- <br /> Remodeling and/or repairing (describe):----------------- ------------------------------------------------- <br /> -----------------------------•-----•----------------------------------------•-------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------.--.......----------------------------------------- ---- <br /> ---------------------------------------------------------1--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------- <br /> -------•----------------•---- ------•-------•-------•--------------------•---------------•---------------------------------....-----------------•---------- <br /> ------------------------------- -- -------- 1-••-----------------­­---------------------------------------------I---------------------------------------------------------- -------------------------------- <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 /> ' i .. <br /> or <br /> (Signed)--------- --•------------ ------------------- Contract <br /> 1 <br /> (Plot plan, showing size-of lot, location of system in rela i n to wells; buildin s, etc., can be placed'on reverse side). <br /> [ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ---- ---------- DATE ,�� � { <br /> REVIEWED $Y------------------------------------ <br /> = ----------- ----- ------ - ------------- - <br /> DATE .-.- ......... .. . .4 . <br /> BUILDINGPERMIT ISSUED-------------i-------------------- ----- -----------------------------------------------------------.- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations: --------------- --------- --- ------- --- r'-•-------•--•-••--------------------------------•-•----••-------------- <br /> -�-= <br /> ------ _ <br /> ------------ �L`z `/,� =� ------- -------- --- J*�...... <br /> I - - -------------------------------••--••---------------•-----•-•-------------• ---• -------------••---------- <br /> I ----------------------------------------------•------------------•------- <br /> ------ ------- ----------•---------- ------------------------------------------------------------------------------------------ <br /> --- -------------- -------------------- ---- - ---- <br /> G <br /> FINAL INSPECTION BY:...- _-:�------------------------ <br /> :-.- Date----- ------------ ------------ --------------------------------------------- <br /> T. 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 1 Tracy, California <br /> r9-9-2M 145446 ATWOOO 12-54 <br />