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APPLICATION FOR SANITATION PERMIT Permit No. ._ ___. <br /> (Complete in Duplicate) <br /> Date Issued <br /> Application 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 /> JOB ADDRESS AND LOCATION-----2_ --4-2-----. ---------------- <br /> Owner's Name----------------------------------a".% -,e,^:7�......... ----------------------------------. Phone__ft 'l------•-•------------•--- <br /> Address--------------------------.......................2 c-�,ic- F' " �'► i rk--------YY A L.. <br /> Contractor's Name--------------------- �•�1�--- ,AE4------------------------------------------------------------------------- Phone----- = Q <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ - Number of bedrooms _--- Number of baths _l.... Lot size ----46.0-----X --— <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Al-eft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 16- New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public ewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well _-Distance` m foundat <br /> ion lC.............Material------ �-- <br /> artments._._ <br /> p !'""--------•------Size---•-- <br /> No. of com +� Liquid depth_.,5.Z...-----.._.Capacity <br /> laC✓ ._ <br /> -------- <br /> 464 " <br /> Disposal Field: Distance from nearest well-47te)--Distance from foundation_7-Q-'P______-Distance to nearest lot line_f_�-__.____ �. <br /> Number of lines___ ___________ _ _ Length of each line,/-V _ # <br /> �� ----- ----- g �-f�---------�;:-----:Width of trench«�f------••-- ;--• -----• - <br /> Type or filter material- �_ --Q-k------Depth of filter material---1-s?-----------Total length�:'r_7"d4t'._� w� <br /> Seepage Pit: Distance to nearest welll'1CA4-------_-_DistanMam/1 <br /> foundation-_o�-�D___:_____.Distance to nearest lot line-_-Number of pits.-.---/-------------Lining materia --------Size: Diameter-J.3 Depth---A-X-" --------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation-----.--------------Lining material--------------------------------------- <br /> 1­1 <br /> ---_--_-:_-_._------_-.__-._--__-___.❑ Size: Diameter--------------------------------------Depth----•-------------------•-------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line----- -------------------•------•---•---•-----------------•--------•-------------------------------------- <br /> Remodeling and/or repairing (describe):---------------------------------------------------------------------------•----•----------•----------------------•----•----------•---------•---------- <br /> -------•------------------••--------------•-----------------•--------•--------------------•------------_-•-----------------•----------------------------------------------•-----------------------------------•----------- <br /> ---------------------•---------------------------------------;---------•-----------------------------------------•-----•--------•-------------------------------------------------------------------•------------------------ <br /> I herelahave prepared this application and that the work wil be done in accordance with San Joaquin County <br /> ordinances, ate laws, an rules 'ind regu a ons of the an Joaquin Local H Ith District. <br /> Q <br /> (Signed) = ------------ Contractor) <br /> By:---------- ........................................................ <br /> (Title) <br /> (Plot plan, showing size of lot, location of system in rel f n to wells, buildin , etc., can be p ced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. -------------------- ------------------------------------------- DATE <br /> ------------------------- <br /> REVIEWEDBY------------------------------ ----- - ---------------------------------------------------------------------------------• DATE----- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------- _------------------- DATE_..-------��--------- <br /> Alterations and/or recommendations------------------------------------------------------------------------------------------------ <br /> ---•-----••---------------------------------------------------------•-----------•--------------- -------------------------------------•••-•-•-- -------------------------------------•---•--------------------- ----- <br /> ------------------ -------------------------------------•--------------------------------------------- -----------•-•-----•----•----------------------------•-------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ---------------------------- <br /> ---------------- -----------------------------------------J---�---------•--/--ij------------------------------ Date----------------------------------•.------------------------------------------------------ ----------------------------------------------------- <br /> FINAL INSPECTION BY:._ _%'LC/1l �'� <br /> ------------------------------------------ <br /> 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 Tracy, California <br /> II ES-9-2M I0-52 Revised W-2100 <br />