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APPLICATION FOR SANITATION PERMIT Permit No. _. - 7 ... <br /> (Complete in Duplicate) 7 <br /> �. Date Issued __M5 Y <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 /> JOB ADDRESS AND LOCATION--- -------------- <br /> J � -- ,,--- <br /> Owner s Name �f7 ...a... <br /> ----------- -Phone <br /> - _ ---------------- <br /> , _.. <br /> Address I -�-- --------- - ----------------------------------------------•-------------------- --------------------- <br /> Contractor's Name-__ - " <br /> � "- {---•-----------------------------------•-------------------------------------------------------•------------ Phone.--.--------------------••-•------- <br /> Installation will serve: Residence J# Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Ej <br /> Number of living units: Number of bedrooms _1,.,. Number of baths _-I---_ Lo;size &-'l'AlA.---------------__----_---- <br /> Water Supply: Public system Community system ❑ Private❑ Depth to Water Table --- ft. I. <br /> Character of soil to a depth of 3 feet: Sand ] Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ r <br /> t <br /> Previous Application Made: Yes ❑- No ® New Construction: Yes ( ] No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t , <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well a'9- -. _Dista ce f m.foundation__IV----_.--.Mayyt��erial--------------_---_:-------._------__.------... <br /> rtm <br /> No of compartments- -- ------ -- .- Size--" _" --------Liquid depth------=l -----------Capacity--9106------------- <br /> Disposal Field: Distance from nearest wefi_30_0. -'Distance from foundati n--- - -_.--_.Distance to nearest lot line.-_! ---._--- <br /> Number of lines------ ----------- ------ Length of each line--- I$?-_'-._ �. <br /> ---- •------Width of trench .,3-4+�- <br /> t Type of filter material_ 's.-Ow -.---Depth of filter material--_--/ _---------.Total length_--r � <br /> --- <br /> Seepage Pit: Distance to nearest 'well---------------------{Distance from foundation_--......-___'-.Distance to nearest lot line----------------- <br /> ❑ Number of pits----------------------Lining material'----------------------Size: Diameter-----------------------Depth-.---------------------------- <br /> 1 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----------------.__Lining material---__- ._----__--------_-_-----_-- 1 <br /> w <br /> Size: Diameter- _ .-_.-- ' -.-._ Dpth --------------- u- <br /> --• `----Licluid Capacity.:---------------------------. <br /> gals. <br /> -, ���c+.;pyo-. 'ice Y' — � ,yam'`. �`__ r _•41F .. �+.�rip- s <br /> Privy: Distance from nearest well-------_-_--------------------------------------Distance from nearest building-----------------------------------_----. <br /> ❑ Distance to nearest lot line-------'----"---- :- �- ----------------• <br /> Remodeling and/or repairing (describe)-------------------------- --------------------•---------------•----------------------•---------•----•-------=... <br /> ------------ <br /> q " <br /> --------------------------•----------.--.----•-•----------------------------------------------.......------•--._..--•----._-.....-------------------•------•-----•--------------------------------------------------------- <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 /> ordinancesaowjngsiz� <br /> ' and rulewnd'reg lations of the .an Joaquin Local Health District. <br /> (Signed)---- -- ----•---• 1_ --- --- ---- ------ --- -------------- ---------------------------------------------------(Owner and/or Contractor)BY: ---•-----...-----------;•-• -----------------------------•------------•------------------•----------------(Title)--------------------------•------------------------------------ <br /> (Plot plan, f lot, location of system in'relation to wells, buildings, etc., can be placed on reverse side), <br /> a <br /> 'FOR DEPARTMENT USE ONLY 1 <br /> APPLICATION ACCEPTED BY-- . ------•------------------------------------- ----------- DATE-- <br /> ------------=-----•---- <br /> REVIEWED BY----- ---------------------- <br /> ---------------- <br /> ----------------------------------------------------------- <br /> ------ DATE.. <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------ ------ DATE_------------------- <br /> Alterations and/or recommendations:------------------------- --------------__--------------------_••:-------- <br /> -------------------------------------------------------------- ----•------------------------ --------------------------------------- •---------------------------------------------------•---------------••----------------- <br /> --------••- <br /> i. -------- ---------------------------- ---------------------------------------------- --------; -----------------------------------------------------------=---------------------.---------------------------------- <br /> r ----------------------------------------- -----------------•----=--- <br /> A ; ---------------------------------------------------- <br /> s� FINAL INSPECTION BY:.. _ Date.= { =, <br /> ---------- ------ <br /> 3 SAN JOAQUIN LOCAL HEALTH DISTRICT . <br /> 130 South American Street' 300 West Oak Stieet " 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ��4-2M Revised W-2100 <br />