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-7-6 - AL APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby e to the San Joaquin Local Health District for a permit to construct and install the work herein described. This m m 's application is made in compliance with Count,/ Ordinance No. 549. JOB ADDRESS AND -------7 _6 ...i.-W. ----- ------ '1---- -------- 7 1 7 Owner's'N8me------------- ---- ---- --- Phone ---------- -A6 -k Address---_----------------- ----- Contractor's Name-----------------• ------------- ----- ----- -----%---- --------r------------------------------------------------------- Phone Installation will serve: Residence Apartment House E] Commercial E] Tra Or Court E] Motel E] Other F1 Number of living units: -------- Number of bedrooms3- Number of baths�Lot size -Water Supply:- Public system �ommunity system E] Private E] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam L] Clay Loam [I Clay E] Adobe 0 Hardpan ❑ Previous Application Made: Yes E] No 191*' New Construction: Yes Ell"No n TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) So tic Tank: Distance from nearest well--h100".z.7Distance from foundation__--f-128_____.:Material------ ---------- ----------- No. of cornpartments-_-?----------------Size__�7X:��___&-------Liquid depth--------9---------------Capacity----- 4? Dis -a].Field: Distance from nearest weil>'-�__.Distance from foundation----/O.r Distance to nearest lot lir ---- -------- le -15-------- Number of lines------------ ------------ ----Length of each line--------(m 10---all...----- Width of french------ -------------------0 I of filter ma feriaf--- ....Depth of filter material---- ........Total length-------J- ------------- ----------- Seepage Pit: Distance to nearest well-----------------------Distance from foundation------------ ---Distance to nearest )of line_'----.----.---- `l 1 ❑ Number ine------------------ Number of pits-----------------------Lining material---------- ------------Size: Diameter--- -------------- Depth-------------- ------------------ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material--___.-..__--_------_-.---_--.-----_. ❑ aterial-------- -- -------------------------- R Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity------------------ ---------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.---.-.-_---------_-----_----_---------.- ❑ Distance uilding----------------------------------------- Distance to nearest lot line----------------------------------- Remodeling ine-- ---------------- Remocle6g and/or repairing (describe]-------------_-----------_ - ------- ------------------------------------------------------ - ---- ------------------------------------------------ ---------------------------------------------------------I--------------------------------------•----------------•---------------------------- ------------------------------------------------ ------------------------------- -- I hereby certify that I have prepared This application and that the work will be done in'accordance with San JoaquinCounty - ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I (Signed-------------------- ----------------------------------------------------------------------------------------------------------------- --------------------------(Owner and/or Contractor) By------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can'-be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- A4q,__114-- ----- - -------------- DATE------ -- ----al--- - ------------------------- REV16WEDBY-------------------------------- ---- ---- - - -------- LT BUILDING PERMIT ISSUED------------------------------------------- ----------- --------------------)------------------------ DATE----------------------------------------------------------- ----------------------------------------------------------------- DATE------------------------- ------------------- A terations ATE-------------------------Alterations and/or recommendations:------------------------- - 0------------------------------- ------------------------ ------------------- ---------------------------------------------------------- ------------------------------------------------------------------------------------I-------------------------- ---------- -----------------------------------------------------------•----------------------------------------------------------------------------------------------------------*------------------•------------------------------------------------------------------------- --------------------------- --------------------------------------------------- -------:----------I---------------------- ----------------------- ------------------------------------- ---------------------------- --------------- --------------------------••--------------- ----------------------------------------------------- I I__ --------- ----------------------------- Uf - - _S_2� ?9 A FINAL INSPECTION BY.-,., --- -------------------------- Date...... ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree+ 300 West Oak Street 132 Sycamore Street 1114 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California _SES-9-21vl TO-52 Rev-ised_WVioo