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ez rt <br /> APPLICATION FOR SANITATION PERMIT Permit No. -� <br /> (Complete in Duplicate) ,�- <br /> Date Issued!!_ -------. <br /> Applica4'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 /> 01 <br /> JOB ADDRESS AN LO ATION- f� --- ----------------------- --- <br /> ----------------- --- -- - /� �J/.. �/ ✓J <br /> Owner's Name-••-•-• aT7 --�"------•- - -------_------- ,-.�-- - Phone ... .. 7 <br /> Addresst ...................................... <br /> �.� <br /> Contractor's Name . --••-•• -------------- ------------------------­--------------------- -._. Phone- _ -/ ��-- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel jil Other ❑ <br /> Number of living units: /-___ Number of bedrooms Number of baths/------ Lot:size ----_,-•.___--__•_-- <br /> Water Supply: Public system P-<ommunity system ❑ Private ❑ Depth to Water Table�ft <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam'❑ Clay ❑ Adobe' lardpan ❑ ,: <br /> Previous Application Made: Yes p No New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T4: Distance from nearest well__ "_Distance from foundation____-.Material__l <br /> No. of compartments--------------------------Size--------------------------------Liquid depth------------------------ Capacity....................... <br /> sposal i Distance from nearest well-----------------Distance from foundation-------------_----Distance to nearest lot line_____._..._______ <br /> Number of lines-----------------------------------Length of each line______________ Width of trench <br /> Type of filter material-------------------------Depth of filter material. -_-•--__--__-_•.-Total length...........------- <br /> Seepage <br /> --Seepage Pit: Distance to nea�e ----------------- <br /> t well. --------Distance fr #ou ation,,e� ...........Distance to nearest lot line__._. <br /> Number of pits-7--- --- ----Lining materia 10 Size: Diameter.+.1!_ Depth----- ..- ---�" <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------------- <br /> El Size: Diameter-------------------------------------Depth...........................................:__...._.Liquid Capacity............................. gals. <br /> Privy: Distance.from nearest well_____--__ ___________________ ____-_-_:Distance from nearest building___,..............- .._...._. __-__-._ <br /> ❑ Distance to nearest lot line-------------------------------- ------ -- .....................................------ ----••---•-- ............ ------------ <br /> Remodeling <br /> --•----•- <br /> Remodeling and (describe):------ ------ -- ---- : `- h-----. --- ------- ..................... <br /> --------------- - •--- ----- ---•---••••-----•---••----......-----••.........----- ----- - <br /> ---------------------------------•--------------------------••-••... <br /> - -----.....-• --•-•--•-- <br /> s` -----------•---------------------------------------------------------------------------------- <br /> ------- - -----••-- ---- -------------------------.................;;I --•---- ----------------------- ----- •----------------... ------. --------- ------------------------ --------- <br /> hereb /certif that I have pre ared t s appl aeon and that the wor e`do ordanceSan Joaquin County <br /> or antes,, ate I ws, and r d r at' 0 San"Joaquin He <br /> .__ .. ._-----` -_ - < ' `m'' ------ nor d Contractor <br /> (Signed) ) <br /> BY� � ---- --- -- ----- ---------•-• ---•-•-- ------(Title) -- <br /> (Plot plan, showing size of lot,'loc ion of system in relation to wells, uildings, etc., can be pla on reverse side <br /> FOR DEPARTMENT USE ONLY <br /> f r <br /> APPLICATION ACCEPTED BY- - - ------------ .------.----- DATE _- ----...-- - <br /> REVIEWED BY------------------------ .- <br /> - ----- ---- --- ------- ----- DATE •-----------. <br /> BUILDING PERMIT ISSUED-- ... •----•------------------- ................................................... DATE. --=fC.. •------- <br /> Alterations and/or recommendations------------------------ ----<---------------------------------------------------------------------------------------f......................-•-----•--•---- <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 Revised W-2100 <br />