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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) DateIssued <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. f <br /> i49�2� <br /> I <br /> . ... .... . . ... .. <br /> JOB ADDRESS AND LOCATION 7,� ------ ------- -- ------ ........ . ----;I--- - ---- ------------ <br /> -- 7 <br /> -- - ----- -- .. . . .......... . .... <br /> ..... . . . . <br /> -------I-------- --------------- -------------- <br /> -- - --- -- ---- - ------------ ------- <br /> Owner's Name-------<:. <br /> ----- ------e------ --------------------------------------------- ---------------- ----------------- -------- <br /> PhonAddress-------------Q- -- -----/ - <br /> 1� I - --- -.-At---- (�41_k_ ___�----- ----- - ------- ------ e <br /> Contractor's Name_ or . <br /> Installation will serve:, Residence Apartment House D Commercial F] Trailer Court E] Motel E] Other <br /> ber of bedrooms Number of baths k- Lot size ---- �V--- <br /> Number of living units- X___ N _00 <br /> Water Supply: Public system � <br /> Nu <br /> system Private [] Depth to Water Table Ivoft. <br /> Character of soil to a depth of 3 feet' Sand. pl--Gravel Ej Sandy Loam 11.1pay Loam E] Clay E] Adobe Hardpan El <br /> ' <br /> Previous Application Made: Yes E] No [V New Construction: Yes o El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool pe'rmit+ed if public sewer is available within 200 feet.) <br /> Septic Ta k: Distance from ne'arest well----------- -----Distance from foundation-------------------Material------------------------------------------------ <br /> No. of compartments... --------- -----------Size--------------------------------Liquid depth--------------------------Capacity----------------------- <br /> Dispo;al Field- Distance from nearest well----_-----------Distance from foundation--------------------Distance to nearest lot line_________________ <br /> Width of trench----------------------------------- <br /> k' <br /> ,!1F Field- <br /> Number,ol lines------------- ---------- ----------Length of each line------------- -- ---------- <br /> El A&a <br /> Type of filter material material_______.-----.------Total length__________________"__-_-.----- <br /> - ---- e _,aDepth of filter __�.Distance to nearest lot line--- <br /> 7 Distance to nearest w� f f4ndafion----0_ <br /> Seepage Distance <br /> -----4--4..�-------Depth----- _._(5------------------- <br /> 5------------------- <br /> Number of pits___.... ---Lining material____ Size: Diameter <br /> ol: Distance from,nearest well-----------------Distance from foundation--- ----------- ---Lining material-- ------------------------------ <br /> .Qesspo 'Liquicl-Gapacity_—_­------ <br /> Size; Diameter---I-------- -------- --- ---------- Depth__ 7 -------- -------------- ---------- <br /> El t <br /> Privy: Distance from nearest well"----------------- -----------I------------------Distance from nearest building------------------------------------------ <br /> i <br /> uilding------------------------------------------ <br /> ElDistance to nearest lot ins__._-"_"_____________- ------------------- ... ------r------------- ---I-------------------------•------------_----------•---.-"'--I --- ---- <br /> ------------- --- ---- -- ----- -A---------- - - ­ ------------ <br /> Rerrr6aeling and/or repairing (describe)------------------ _---- -- - ---- ------ ----------------------- -- - <br /> j --------- -- ---- <br /> --------------------------------------------------------- <br /> .i- <br /> ------------------------------------------------------------ ----------------- F— - -- ---------------- - - --- - - --------%--------------------------------------- <br /> 4 ----------------------------- ----------------------------- ------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and at the workSan -- ------ <br /> -------------- --------------------- <br /> ----------------------------------------------- will one in accordance with S a n Jo aquin County <br /> ordinances, State laws, and ales and regulations of +h San oaqui Local Healt Disfr' f. <br /> c or)(Owns or Cop4a f <br /> (Signed)---------- ---- ------ --- ----- --- <br /> ---- ------- <br /> 1 -------------- <br /> ---------------------------------------_----------------(Tit <br /> By:--------4- ...... ------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> - <br /> FOR DEPARTMENT USE ONLY <br /> DAT <br /> '- <br /> APPLICATION ACCEPTED BY-- ------ ----- <br /> REVIEWED -------- <br /> ----------------------------------------- <br /> BY----------------------------- ------------ ------------------- ------ --------------------------------------DATE DAT Ate ------------------------------------------------- <br /> ---------JA---------------------------------------------- <br /> BUILDING PERMIT ISSUED----------------- ------------------- --------------Qf\ <br /> Alterations and/or recommendations:______-----".------- . ­_________------------------------------------ -------- ------------------------------- <br /> --------------------------------------------------------------------------- <br /> ------------------------------ -----------------------------------------------------------I------------- - ----1-1-------------11...... <br /> -------------------------------------------------------- ----------- ------------------------- --------------------------------------------------------------------- -------------------------- <br /> ------------------------------------------------------ -----------------------------I---------- ------------ ------------ ----------------------- ----------------------------------------------- -- ------------------ <br /> ------------- <br /> -------------------­------------ ----------------------------- -------------------- <br /> ----------- ------------------------------------­------------------ ----------------------------- ------------------------- ----- <br /> --------------------- <br /> FINAL INSPECTION BY------------------------------ -AV------ -- <br /> Date_ .------------------------- ------ - - ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 Sycamore Street 814 North "C" Street <br /> 136 South American Street 3oo West Oak Street <br /> 'California Lodi, California Manteca, California Tracy. California <br /> Stockton, <br /> Es-9-2M 745446 ATWCIrID :2-54 <br />