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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 0 ante No. 549. <br /> JOB ADDRESS AND LOCATION..... -- ------,.... ... iy............. <br /> Owner's N ............... Phone...,.?.... <br /> Address-_.... --..... - ----- ---- ------------ ........-----------.................................. . ... ........ <br /> Contractors Name------------------ --------------------- ---- .. ............... ... ...................__--_--------- Phone-'A_ e <br /> p <br /> Installation <br /> will same: ResidencV Apartment House E] Commercial [] Trailer Court [] Motel 0 Other 0 <br /> Number of living unifs:l_- Number of bedrooms Aw—f Number of baths _/---- Lot size .------------------------ <br /> Water Supply: Public system 0 Community system El PrivateW Depth to Wafer TabI940'&Pft. <br /> " <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy loam E] Clay Loa Clay El Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes [] New Construction: Ye No <br /> TYPE OF INSTALLATION AND SPEAFICATIONS: x <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept' Tank: Distance from nearest well..---_.. - --------- <br /> Distancip from foundafioq/Z-7---------- <br /> No. of compartmenf�.4_­.... Sizlg� JFJ� 'depth <br /> __._.Capacity....- ' . <br /> I Field: Distance from nearest well... -Distance from founclatioq,.�I�P--- ------Distance to nearest lot line.....✓5 <br /> -- <br /> Number of lines---- --- <br /> --------- ­ ----Length of each line------/4-- ------Width of french-.1- ----- <br /> / - <br /> Type of filter materia --.,--.Depth of filter material---- ------Total length-------- A <br /> IF ?Z=F---------------------- <br /> Seepage Pit; Distance to nearest well-- - ----------- Distance f rin fo ation-/4,7Z-------Distance to nearest lot line----- <br /> r <br /> Number of pits.... Lining mater" -.Size: Diameter....I.; Dept h...a——---------------­-- <br /> /-------------- ;�4 <br /> C�Ixllplol: Distance from nearest well---------...... Distance from foundation .. .........Lining material------------------------------------ <br /> 1:1 Size: Diameter.-...------------------------_-----.Depth........................__........................Liquid Capacity..------------ -----------_gals. <br /> Privy: Distance from nearest well.- .--. ......................._---- -------Distance from nearest building.__._.------._._-__-__---_-----_-_. <br /> ❑ <br /> uilding---- ---------------------------------- <br /> F-1 Distance to nearest lot line.---- ..............._- -------- -------------------------------------------­---­---;........... ......­--------------- <br /> Remodeling and/or repairing (doscribe):._1/L16l ------ ------------------------------------------ —------------------------------------- <br /> ---------­-­---------------------------------------------------------------------------------------------­­­-------------------------------.................................................. -------....... <br /> - ------------------------------------ - - ------------------------------------------------ --- ---I---------------------------------------------------------------------------------------------—--------- <br /> ----------I.........-------------------------------------------------------------------------------------------......................................................................................................... <br /> ii I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Statip laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Owne. d/ r Contractor) <br /> .................................................................... ­------ <br /> By:.... ----------- ..I • --------frltlaj�_ <br /> '41- -------- ----------------------------------------------*----------------- ---- -------- <br /> a location of system in relation to wells. buildings, etc., canreverse <br /> (Plot plan, showing , a be <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY<},.....�7................................. ................................ DATdo <br /> .....-------- ------............... <br /> REVIEWEDBY------_----------------------- ------- --------------------------------------------------------------------- DATE__f_,_,,...............................­.............. <br /> BUILDING PERMIT ISSUED.................... <br /> . .....I............................................. ............... DATE------Aj............-----------------------_------------- <br /> Alterations and/or recommendations:-----..............----------- .................................................... <br /> ----------­------------- ..... --------- <br /> ---------- ........ . ----------- .......... <br /> -­--------------------------­­; <br /> . ........................................................................ <br /> -------------- ....... ....... ..... .... -------�:---------- <br /> ....................................................................­­­­.......................................................................................................................................... <br /> .................................... ------------------------------------------­-------- --------..........................................I.......................................................................... <br /> FINAL INSPECTION __ -_---------_---- Date.........1�3 , j 4/, -.6, <br /> .......................................................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South A.eriiea. 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 />