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APPLICATION FOR SANITATION PERMIT Permit No.... ..l.. ..,�. <br /> (Complete in Duplicate) Date Issuedy'r//' <br /> Applica{ion 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 /> 0. <br /> * . <br /> rJOB ADDRESS*NDCATI - z <br /> Owner's Name- --•--- --------- -------- Phone--------------------------_----_-------- --- <br /> ------------- <br /> --- <br /> Address-•-----•------------ - --- ••�---- -------�- --- .. . -------- <br /> r <br /> Contractor's Name--.--- _ -------- Phone------------------------------------- <br /> Installation <br /> ------------------------------- •- <br /> installation will serve: Residencl!e x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..-I-____ Number of bedrooms _a-_ Number of baths J--- Lot size ______�_. -------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table.- _ t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravely Sandy Loam K Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 0 New Construction: Yes X No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: # <br /> T (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . <br /> Sep}ic Tink: Distance from nearest well-----------------Distance from foundation--------------------Material----_-_-..--_____-__-_-.__-----__----_---__-_._ ' <br /> No. of compartments--------------------------Size-------------:------------------Liquid depth------- - - ---------Capacity------------- -- <br /> I Fiv Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 8p8 <br /> Number of lines-----------------------------------Length of each line------------------------. ---.Width of french.---------------------------------- + <br /> Type of filter material-------------------------Depth of filter material__-...._._....._..._ Total length------------------------------------------ .4 <br /> Seenaae Pit: Distance to nearest well___]0_Q-`F____-pistance from foundation__-----_.._ _ stance o nearest lot line-_-_ . <br /> Number of pits---, --------- _L" i -------------Size: Diamet r-------- .. ._#Depth------- <br /> Cesspool: Distance from nearest well--- ante om foundation.___---------------Lining material-------------------.---_-_--------_. <br /> ❑ Size: Diameter --- . epth--- - ---------------------------------------------Liquid Capacity--------------------------gals. _ <br /> Privy: Distance from nearest well--.-...T--------------------------_-.___.-._-Distance from nearest building -------��-----��'------. 4 <br /> ❑ Distance to nearest fot 1ine-------------------------------------------------------------------------------------- ------------------------- ----------------------- � <br /> Remodeling and/o r pairi (descri4�e�:- '''� ?_--- -- ! .. a--------------' �Y <br /> -- - -----�- "# f <br /> -------- - - ---------------- ------ ; <br /> :: t:=: _ == _____ __ _ ____ _ ------ <br /> ereby c�c"r�ify t at ave prepa d this application a d that the wor cV Zlf&rdone in accordance with San Joaquin County <br /> ordinances, State laws, nd rules anJ re ulations; of fh San J quip Local Health District. <br /> nn <br /> (Signed) -,. t - ----- - -- ----------- : -(Owne nd/or Contractor <br /> ..BY::------z 4. ----- =,_ _ ___. --•-------- ------- --- - - <br /> (Title-_ <br /> a..:__.._ ,• • <br /> (Plot plan, showinei e07'rfot, to ion of Sys em n relati n to wells, buildings, etc., can be pl ced on verse e). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -------------------------------------------------------------------------•-------------------- DATE-------- <br /> REVIEWEDBY------- ------------------ ----------- --- --- ---------------- •-- ----- DATE.-..----- --- <br /> BUILDING PERMIT ISSUED -------------- --- -- -- - DATE <br /> --------------------------------- <br /> Alterations and/or recommendations:--------- ------- ----=- - ----------- ----------•------------•---------------------------- -•----_--------------•--------------------- .._.. �� <br /> -----------------------------•------------------------------------------------------------- -----------------------------------•---------•-----------•---•--••--••--------------------------•------------------------ <br /> ---------- -----------------------------------------------------------------------•---------...--------•------------•--------••---------------•------------•--------------•-•---------•-----------------------------------­- <br /> -----I----------------- <br /> ------------------------•--• ------•-•--------------- ------------- --------•------------- ------------------------------------------------ ----------------- •-------- <br /> r <br /> FINAL INSPECTION BY:................. ..... .. : Date............... _ �_ v <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockfon, California E Lodi, California Manteca, California Tracy, California <br /> - E5-9 145446 ATWOOO <br />