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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 D LOCATION---- ------ ----Y_/ ------------------- <br /> Aff <br /> Owner's Name- -- ---..-. ---------------------------- ----------------------- Phone_�__'�rr ..- <br /> Address.. -7/--7 --------- ---- - --- - --------•------ -------------------------------------------------------------.._... <br /> ......I---------------------------------------------- <br /> Contractor's Name ...- -•- ----------------------------------------------------------- ----- ------ Phone---------------------------------- <br /> -- ------------------=--------- <br /> Installation will serve: Reside ce Apartment House ❑ Commercial ❑ Trailer Court ❑ iMoot9I ❑ Others❑ <br /> Number of living units___ umber of bedrooms __ . Number of baths _Z_ Lot size __ _l1-__ _�_ ------------------------ <br /> Water Supply: Public systerri [►Community system E]`Private ❑` Depth to Water Table ____ __ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> I ) <br /> Previous Application Made: Yes 0 No New Construction: Yes No ❑ , <br /> TYPE OF INSTALLATION A6 SPECIFICATIONS- <br /> (No septic 4p p i�� le within 200 feefs) , <br /> No se tic tank or ces pool ermined if ubiijm�_1isfance6_rom­0'f_" <br /> er is avail b Septic ank: Distance rem nearest welr d�a+�'z11�___ <br /> No. of compartments_.___ ---_ ___.__.__/Size quid depth_._ 'r_.-_---____Capacity--:�_— <br /> j Dispos Field: Dis+ance from nearest well _ �`E�istanc from foundation�� stance to nearest to line__ <br /> Number of lines__________ _______ _ ...____ _Length�aeach line___-_ __-__ __ .� Width of trench_______ <br /> Lf <br /> t.. <br /> P Type of filter mater epfh Lf filter material--------l___CJ_____-Total length_______-__1__ / <br /> .�... Rig-- . <br /> Seepage Pit: Distance to nearest well______________________Distan e�from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ Number of <br /> Cesspool. Distance <br /> material �---•- ------------Size: Diameter------------------------Depth--------------------------------- <br /> pool: D tanee fromnearest well-_ ]]istanc from foundation--------------------Lining material---71 <br /> Size: Diameter----------------------------- - Depth---- ----------------•---+ ---------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well______.__I_______________________.__.__________Dis,ance from nearest building----------------------------------------- . <br /> F71 Distance to nearest lot line--------------------------------------------- --•---- <br /> Remodeling and/or repairing (describe)---------------------I-------------------------------•----------• -------- •-•---------------•-- ---------------•--.._...---------------------------------- <br /> --------------­-----------------------------------------------------------------------I <br /> -- • - <br /> I <br /> I i <br /> -------------------------------------------------------------------------------••-----•-- ----------- ------- -----------------•-------------------------------------•------------------------------------------- <br /> i: I hereby certify that i have prepared this application and,that the work will be done in accordance with San Joaquin County <br /> ordinances, St laws, and rule nd regulations of; e Sari Joaquin Local Health District. <br /> - -----(Owner and/or Contractor) <br /> ... <br /> By:-----------------------------------•--.. -•----------------------------, <br /> (Signed)-- ---------------------------- -•--------------]!-------------(Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED gY DATE ----------------------------------=------------ <br /> REVIEWEDBY------------------------------ ------ --------------- ------------------------------------------ DATE------ - --- <br /> BUILDING PERMIT ISSUED-------------- -------I------------------------------------- <br /> DATE <br /> Alterations and/or recommendations:--.-----•----------------- t--------------- -------•-------------------I--•---••------------- ------------ .._.. <br /> ------------------------------------------------------.•-------------------- ----- ---------------------- ------------------------------------------ ------------------------------------------------------------ <br /> -----•------------------------------------ •---------------------------------------------- ----------- -- - -------------------------------•-----------------------------------•-----------------------------•------------ <br /> FINAL INSPECTION BY:---------- - --- --------------- Date----- <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 /> ES-9-2M 10-52 Revised W-2100 <br />