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APPLICATION FOR SANITATION PERMIT Permit No. /a -Z__-_- <br /> (Complete in Duplicate) <br /> ' Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constru t and ' stall the work herein described. <br /> This application is made <br /> in compliance ith County Ordinance o. 544. x/ <br /> JOB ADDRESS A CAT N-- -------------------- - - - <br /> ------------- ------------------- <br /> ---- --- - ---- <br /> Owner's Name, ---- ---------------------- ---------- ---------- ---------------------------------- ------ -- Phond-- -- - ----`-�� ------ <br /> 7" ` <br /> Address i _ <br /> Contractor's Name------..._ <br /> k - -------------------------------------------.-------------------------.-------------------------------- Phone----------------------------------- <br /> � <br /> Installation will serve: Residence ff�Apartment House ❑ Commercial ❑ Trailer Court ❑ Moth ❑ O her ❑ <br /> Number of living�units:'___l.__ Number of bedrooms%3--- Number of baths ---/-. Lot size --6,7__)(--'--�'6�_j_____________ ___ <br /> Water Supply: Public system Rj/Community system ❑ Private ❑ Depth to Water Table -0.7 ft, <br /> Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ 5 ndy Loam E] Clay Loam [-] Clay EDAdobe [Hardpan ❑ <br /> Previous Application Mede: Yes ❑ No LTJ' New Construction: Yes 2/'No ❑ FHA/VA: Yes ❑ No E� <br /> TYPE OF INSTALLAI 8N AND SPECIFICATIONS: ' <br /> (No septic tank or cesspool permitted if ZlAwPTstanc <br /> ' sewer is available within 200 feet.) <br /> Se ti Tank: Distance from nearest well__ from faun ation___ _4_�____-MPial _- <br /> p c/ No, of compartments---7- V <br /> © ---- Size--':2.x A� ------Liquid depth---------------- -------1 Capacity--- ----- <br /> Disposa/Field: Distance from nearest well.. . 4 Sistance from foundation _AP_!_______Distance to nearest lot lige---- <br /> Nirriber <br /> Number of lines-------- �-- pth­of-fil <br /> gth of each line_____- -_____.Width of trench __ ---_-- <br /> E - ------------ <br /> Type-�•offilter-matera ..,- ter-material=-7nf-f __ ____._Total length____c ___ _________________-____-__ <br /> Seepage Pit: Distance to nearest we}l------------------------Distancefrom_foundation__-_____-________-_.Distance to nearest lot line________________ <br /> ❑ Number of pits----------------------Lining material------------------------Size: Diameter---------.-------------.Depth--------------------------------- <br /> t <br /> �•.. " <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------.-----Lining material------------------------_____________- <br /> ❑ Size: Diameter--------------------------------------Depth---I---------- ------------------------------------Liquid Capacity----------------------------gals. , <br /> Privy: Distance from nearest well____ ...____________________ #--_.___-__j_____Distance from nearest building-----_____.__________________--_-------_-, <br /> ❑ Distance to nearest lot line___________________________________ _ <br /> Remodel;ng and/or repairing (describe)_______________________________________________ ___ <br /> -----------------------------•-------- ---------------------I------------- -- ----------------------------`------------------ ------ --------•--•---------------------------- <br /> a <br /> ---------------------------------------- --------------------------------•----------------------------•---------------------------------•-------------------------------------------------------------------------------- - <br /> ------------------------------------ ----------------------------- ----------------•------------------- ---------------------------------•---------------------------------------=--------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and.-rules and regulations of the San'*Joaquin Local Health,District. <br /> S . <br /> � �� <br /> (Signed)---- <br /> -------- <br /> -- -------------= - ------------ ----------- --------------------------------------------------------------------------------------.(Owner and/oCon+ractor <br /> gY� ---------------------------------------------------------------------------------------(Title)----------------------------------------- <br /> (Piot 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 ACCEPT'E[D BY_::_._..;__,___�..._: =---= ------_----DATE., � <br /> J ----------- ---------------- <br /> REVIEWED BY DATE f -----------------------•------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------- <br /> Alterations and/or recommendations------------------- ---- ---------------------------------------------------•---------------------------------------- <br /> ------------ <br /> -----------------------• ---------------------------------------------------------------------------------------------------------•---•----------•-----------•------------- <br /> ---•--------------- --- --- ;----- <br /> -- ------ <br /> ----------- <br /> ---�-----7--1- <br /> ------------------------- <br /> ---- ------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSP ON ---------- i Date---- ' 8''_.. _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street �i300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M , ,Rayis6d''1' 57 F,P.CO. <br /> v L f— <br />