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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) <br /> Date Issued <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 wit County Ordinance No. 549. <br /> k <br /> I <br /> JOB ADDRESS 4(QDD LOCATION. -•------------ - -------------------- <br /> �tI ---) '__.. ---------- <br /> Owner's Name - ------------------=-- - - Phone <br /> J7-- � <br /> Address---6_� �j --------- --------------------------------------------- <br /> Y --- <br /> Contractor's Name.-- --------- --- -------------------------------------------------------------------------------------------------------- Phon6------------------------------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ otel [:1 Other [INumber of living units: J____ Number of bedrooms _-Z- Number o baths ___/___ Lot size ---1__T__________ ----___--------------------- <br /> _ i <br /> Water Supply: Public system E] Community system 'D Private Depth.to Water Table<Ia� .Zj <br /> ft. <br /> Character of soil to a depth of 3 feet: Sand . Gravel ❑ Sandy Loam Clay Loam Adobe[] Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes DNo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank- Distance from nearest well,--- <br /> ell.- _12_____Dista ce from, fou y tion_____C�__-_--_-_.Mate 'a)_. .- ___ �. j <br /> No. of compartments----------- ------- Size�_k -- .--Liquid depth--------�-/-----------Capacity___-�-_W_ - -!� 1 <br /> eJ___. �__ Distance from foundation to nearest lot line_ <br /> Disposal Field: Distance.from nearest w <br /> JJ <br /> Number of lines__________ -_Length of each line_______________1___ �tv ---Width of french------------ <br /> len th ----l-,/�--0------------------= <br /> Type of filter mate ri - -Qepth of filter material--_____d_�.-___ g <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------_.......Distance to nearest lot line___-_-_________-_ <br /> ❑ Number,of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth_e__:------------_-----------.---v <br /> Cesspool: Distance from nearest well------------------Distance from foundation_'------------------Lining material_:__________---_-__________-_-__ .. <br /> ❑ Size: Diameter_ Depth ------- Liquid„Capacity :aga , <br /> -- ,_ _ <br /> r Dista` <br /> Privy: x Distance from nearest well------------------------------------------------- ante from nearest building__-._-_-__.________•--________..._.______- <br /> ❑ ''stance to nearest lot line------------ ------------------------------------------------------------------------------------------------------------------------------•- <br /> Rmoddlin and or re airi descri. eI----------------------------------� - 't"=-_c4-'r' :¢ :-'�:'-� .`"/------•-_-- <br /> }` �� ------------I <br /> ------ 1�- `�`+~ <br /> --• -- <br /> ----------- --------•--------------------------•-------------------------:..-----------------------------------------------................. R_ ------- <br /> ---------------------------------- – - <br /> ------- -------------------•--------------•-------------------------------- ------ ------------------------------------------------------------------ 4T`r _. .. <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. 1 <br /> [Signed)__ <br /> --------------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:---------------•---•-------------------_-----------------------------------------------------------------------------------------(Tifle)----------------------------------------------------=---------- <br /> (Plot 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 ACCEPTED BY DATE��-------------------------------------------------- <br /> •---•------- ------- <br /> REVEEWED BY---------------------------- .---------------- - ---------------------------------------------------------• DATE---- ----•- � <br /> f41;- <br /> BUILDING PERMIT ISSUED.---- - ----------------------------------------------------------------- DATE. =. <br /> Alterations and/or recommendations:----------------------------------------------- --- -----------------------------------...--------------------------------------------.._..-----_------------ <br /> -------------------------------------------- - --------- ------------------- ------------ ------------------------------------ ---------­----- ---------------------- --•---- <br /> ----------------------•--------- --------------------------------- ----------------------------------------------- --------------------------------- <br /> - -------------------•--•------- <br /> ••-- ----- -- ---- <br /> FINAL INSPECTION BY________________ __ �- - <br /> 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 Lodi, California Manteca, California Tracy, California <br /> ES---9-2M 8-51 Revised W-2100 <br />