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APPLICATION FOR SANITA�TIO ,PERMIT Permit No. ------ <br /> (Complete in Duplicate) Data Issued ----- --- --- -- <br /> _'. plica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> 4Ape <br /> This applicatioiP is'made in compliance with County Ordina e No. 54P <br /> JOB ADDRESS AND LOCATION ..... <br /> v ------------- --- <br /> _o <br /> Phone.Owner's Name-------- Phone- <br /> - <br /> ----- -------------------------------------------- <br /> Acid resfs_",��l <br /> - ---_------------- -­------------- ------ ------------ -- ------------------------------------------- ----------------------------------- <br /> - ---------- - <br /> -- <br /> Contractor's Name - --------------------------------------------------------------------- ----------------- Phone------ <br /> --- <br /> Installation will serve: Res;cltnce Apartment House E] Commercial F1 Trailer Court E] Motel [] Other 0 <br /> Number of living units:,--/----- Number of bedrooms _/--- Number of baths -- Lot size --- __A --------------- <br /> Water Supply: Public system E] Community system E] PrivateX Depth to Water Table 44::qft. <br /> Character of soil to a depth of 3 fee+: Sand [] Gravel F] Sandy Loom El Clay Loam E] Clay E] Adobe,( Hardpan ❑ <br /> Previous Application Made: Yes F] No <br /> I X New Construction: Yes1V <br /> No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:. <br /> (No septic tank.or cesspool p6miffed if pU65'llc6e4er is available within 200 feet.) <br /> - 7 <br /> tic Tank; Distance from nearest well -Distance from founc1afion__/A`-57------Mat 9ria j____ <br /> ------------------- <br /> No. of compartments-..-O-------------------Sizeg-:"-- ------Liquid dep.th.-J—_ ----Capacity-- <br /> Disposal Field: Distance from nearest well_-- Distance from foundation__ Distance to nearest"lot line <br /> .......... <br /> r' of line. -------------- <br /> Numbe Length of each line___----_ Width of trench.-----. --------------- <br /> Type of 'filter materia l�-�-­T­ _(,Depho filter material-..___l_ ___--.-Total length------------- .___._---.---._-X <br /> I ;I I _- -- <br /> ----------- <br /> Seepage Pit: Distance to nearest well---------------------Uistanc6 from(foundation-':.v---........Distance' to nearest lot line__.------_----_.- <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.-._,----------_-------Depth---------------_------------- `^"`" <br /> Cesspool: <br /> epth--------------------- <br /> ---------Cesspool: Distance from nearest well-----------------Distance from foundaf ion------------------- Lining material__.-_---__-__--.-.._-,----------_--. 9 1 <br /> ❑ <br /> aterial-------------------------------------- <br /> 0 Size: Diameter ----------Depth------ -------------- -------F -------------------.-Liquid Capacity----------------------------gal <br /> Privy. Distance from nearest well---- -- ---- ---------------------------------Distance from nearest building___.-------_____------_----------_-----. <br /> ❑ <br /> uilding-------------------------_--------------- <br /> F1 Distance to nearest lot line------------------- --- ------------- <br /> Remode and/or repairing -- -------- <br /> 4 -- ------- ----C---------------- ------------­ <br /> ------------------- <br /> --- ---------------- --------- -- --------- ---------- <br /> ---- ----- --------- ­_5�_?------ <br /> ----- ---- ----------------------------------------------------------------- ------------­-­-------------- -------- ------------ ------- ------- -----------t------------------------------------- <br /> I hereby certify that I have prepared this application and + at e work will be done in accordance with San Joaquin County <br /> ordinances, StatpAarws, and rule( d regulations of the San Joaquin Local Health District. <br /> {Signed)-_-____ - ---------------------------------------------- - <br /> Owner and/or Contractor) <br /> ---------------- ----- --- <br /> By:----------------.................... .­------------------------------------------------------------(Title)_-- —------------------------------- <br /> (Plot plan, showing size Of lot, location of system in relation to wells, buildings, etc., can be plated on reverse side). <br /> Ile <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ..... ... ...... ------------------ DATE-- <br /> ------ <br /> -------------` � ------ --------------------------------- - Gj ---------------------- <br /> REVIEWED BY----- -------------------------------------- ---- ----- DATE---_ <br /> BUILDING PERMIT ISSUED_-.._.... ---------------------- ------------ <br /> ----------------- DATE-------------------------Y, <br /> 4Iterations and/or recommendati f <br /> on ........ Z <br /> -----------F--------------------------------------------------------7------------- <br /> Fr <br /> ---------- --------------------------------------- ----------------------------------------------•-•--. ........ --­----------------- ----------------------- ............................................................. <br /> ---------------------------------i­­­-­................................................. --------------­------­­--------- --­---------- ----------------- ------------------------------ ------------------------- <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 Lad!, California Manteca, California Tracy, California <br /> ES-3-21A 145446 A7WnnD I2-54 <br />