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APPLICATION FOR SANITATION PERMIT Permit No. .:, _` _!____.. <br /> (Complete in Duplicate) <br /> Date Issued <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 /> 97-� <br /> JOB ADDRESS AND LOCATI N----------- � � CP- - ------- ------------------#-------------- -­----------------------------------- <br /> Owner's Name - -- ------ -----••------------ -" '^ --------------------------- Phone----•-------------------•--•-------- <br /> Address j....... ---------------- " ------- <br /> J� _ � _,-1 � <br /> Contractor's Name-_."_7 ------V +� �- f r_-•-----._. Phone;-J-- -•--- <br /> Installation will serve: Residence 01-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ N mber of bedrooms ___-'.a' 1�umber of baths -__� of size . __ _�°_ ___ ____-._____ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table t.j' <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑­<arddp-ann'❑ <br /> Previous Application Made: Yes �o ❑ New Construction: Yes ❑ No W,­- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu lic sewer is available within 240 feet.) <br /> 0. <br /> Septic Ta Distance from nearest well__. _!i�Distanc fro_ foundation_ /�__-_.Material____ _______________ a2r <br /> No_of compartments-.. ----------Size Liquid de th._� _/`-_-____- C � o17< <br /> OF <br /> 1 ` <br /> spos Id: Distance from nearest well_________________Distance from foundation---.___-------------Distance to nearest lot line................. <br /> Number of lines-----------------------------------Length of each line__---------------------------Width of trench-------------•--------------------- <br /> �i Type of filter material-------------------------Depth of filter material-.----___--________--.Total length___-_-________________________________-___ <br /> $c:eepage`P'fc Distance to nearest well_____-_-____-__-_-_--Distance from foundation--------------------Distance to nearest lot line_-_-_---_---_____ <br /> Number of pits--------------------Lining material---------------------- Size: Diameter-----------------------Depth-------------------- <br /> Cesspool: Distance from nearest well----------------- from foundation.-------------------Lining material-------------------------- � <br /> ❑ Size: Diameter--------------------------------------Depth--------------------- ------- -- -----------------Liquid Capacity- •------•--------------gals. <br /> Privy: Distance from nearest well------------------_-------_----------------------Distance from nearest building--------------------------------._____-_. <br /> ❑ Distance to nearest lot line---------------- -- ---------•----------------- -._------------------•---•-•----------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):-------- - --------------------------- ----------------•---------------.............._------------------------------------•------------------------------ <br /> ---------------- _____________________ :p <br /> __________________________________________---.--_______________________________________________________-_______________-_------______________-_______-_________________--_______-•-___-_______-________________._______-__-_-._ <br /> _____________________________________________________________________________________________________________________________________________________________________________________________-_-__-.__________-__---- <br /> I hereby certify that I have prepared this application and that the work will be done in accor7___(-j?wner <br /> with San Joaquin County <br /> ordinances, State laws, anWiles mepulations of the Sa oaquin L cal Health District. '� <br /> TT I <br /> (Signe Septic Tank Service --- and/or Contractor) s <br /> ------------- - <br /> 12045o.Elilorciao 'Hd? fl f, , <br /> Stacktflsx,._Calsf.------------ -------------- --- ---- -�----b- -----(Title)----�A-( �.c.------------.----------- ------- <br /> (Plot plan, s owing size of lot, location of system in rel io to we ls, uildings, a c/ can be placed on reverse side). <br /> FO 9&ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- --- --- -- --- ---------------e DATE ------------------ <br /> REVIEWEDBY----------- - ------------------ DATI -----------•----••------------- <br /> BUILDING PERMIT ISSUED - -� ._---�� - <br /> ------ ---•------------- ----- DATE. <br /> Alterations and/or recommendations:------- -------------.-- � ------------- -----------•---------------------- -----------------•-•---•------------•------------- ------------------- <br /> ------------------------­---- <br /> -------•---------- <br /> ---------- ---------------------------•-----------------------••------------------------------------------------. ----------------•------------•---------------------•------------------------------------•-•------------- <br /> -----•-----------------•---------------- --------------•------- -------------------------------I---------------------------------- --------------------------------- ----------------------------'-------------------------- <br /> -------------------------------- ----------------------------------•------ ------------------ <br /> FINAL INSPECTION BY: Date <br /> � <br /> SA JOAQUIN LOCA � ' <br /> DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> .0 <br /> r <br /> ES___9 igsgas ATw000 1 <br />