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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) <br /> - — I -- Date Issued .... <br /> Application is hereby' 9-- <br /> made to the San Joaquin Local Health District for a permit to construct and install the work h.erein described. <br /> This application is made in compliance with County Ordinanc No. 549. <br /> JOB ADAZESS"AND L90 NTI 0 --- <br /> ,g -----ji--------------- <br /> Owner's Name----------- - ------------------ --- ------ ------- <br /> Address..------ - - - ---- -------------------------------- ----- Phone-- <br /> -------------,---------------------------- -- -- <br /> Contractor's Name__________________ <br /> ---------------------------------------------------------------------------------------- ------------------------------_-- <br /> ------------ -- --- ---- --- <br /> Installation will serve: Residence El , ;------------*----------------------------------------------------------- Phone""--------------------------------- <br /> Apartment House Ej 'Commercial El Trailer Court E] Motel ' Other <br /> Number of living units:IT- Number of bedrooms Number of ba <br /> Water Supply: public Syste, baths Lot size __7 <br /> rn E] Community system ❑ Privat 7 . .. ..... ................. <br /> Character of soil to a depth of 3 feet:; <br /> . Ou Depth to Water Table -------- ff. <br /> eefi, $ El Grave) Ej Sandy Loam 0 Clay Loam E] Clay F <br /> Previous Application Made: Yes 0 [1 New Construcfi -1 Adobe C] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: on: Yes <br /> ❑ <br /> (No septic tank or cesspool Permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest.well <br /> I Distance from found ption----/_0---- ---- <br /> --------- Liquid depfh (._ Capacity- -------------------------- <br /> No. of compartments Mafer*aI <br /> Disposal Field. Distance from nearest welt_. "---"Distance from foundation---- <br /> Number'ojr fines_______-_ Length of each line 7,,g-7 ------- Distance to nearest lot Ii6e --'�------ <br /> (T <br /> Width of french.-_-- <br /> Type of fitter material---- <br /> ----------------- <br /> -Depth of filter material-_." ------------Total length------- <br /> Seepage pit: Distance <br /> 'to nearest well------Zo <br /> Number of 0s---------I-----------Lin i.n-g material--___.-gn ou Distance to nearest lot line----- <br /> ize: Diameter' <br /> IL ------Distance fro f ndation_,'_/P_ <br /> Cesspoo�: Disfance:frorn nearest weil S Diameter____-"""- ,Fr---- __Depth-----------40-f-------------- <br /> 171 Size, Diameter--------------------------------------Depth------------ <br /> --Distance from foundation---------------------Lining material-.. <br /> ------------------------------------Depth------------- ------------------------------ -------Liquid Capacity------material_.._____._____ <br /> ❑ Distance from nearest well--------------------------------------- -------- Distance from'nearesf building ----------------------gals. <br /> ❑ Distance`fo nearest lot-line <br /> ----------------------------------- <br /> -----Remodeling and/or repairing (describe}:------- --- •- , ----- <br /> •------•------•----------•------•---------------- --------- ------------- --------------- - <br /> -----------I---------- ----------------- .. - <br /> ------ -- <br /> ------------------------------11------------ -------I------- -------------------------------------------------- -----------------P_Z? ---------- <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 laws, a d rules and regulations of the San Joaquin Local Health District. <br /> (Signs cr?<_----- <br /> - - --------4'V_ --------- <br /> By_____________-------------............... -- - -----------(Owner and/or Contractor) <br /> _­---------------- <br /> -----------------------------------------------------------------------------------(Ple)-- 11 ----------------------------------- ---- -of Plan, showing size of lot, location Of system in relation to wells, buildings, etc., can(Titl be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> REVIEWED BY-------------I ------------------------------------- BATE------ <br /> BUILDBUILDING PERMIT ISSUED_ ------------------------------------------------------------------------------- dATE __-------P----- <br /> ING ------- -------------------------------- <br /> Alterations and/or recommendations----------------------------------------------------------------------------------------------- DATE----- -------------------- <br /> -------------- ------------ ------------------------------------------------- <br /> ------------------------------------------------------------------------- �- -------------------- --- ----- ------ ------- ----- <br /> ---------------1,5 ------ --------------------- <br /> - ------ ----------------------------------- ------- <br /> ---------- ------------- -------r------- --------- <br /> --------------- <br /> ---------- -------- ---------- --------------------- <br /> Ile--------------------- ----- <br /> ----------�7 <br /> ----------------------------------------- ------------- --------------------- ------------------ -------;�t--------------- ------------------- - ---- ------------------- <br /> a <br /> '17-------- --- ---FINAL INSPECTION BY: <br /> --------------- <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> Stockton, California 132 Sycamore Street $14 North "C" Street <br /> Lod;, California Manteca, <br /> California Tracy, California <br /> E5-9-2M 10-52 Revised W-2)00 <br />