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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued S <br /> Applica+ion is hereby made to the San'Joaquin Local Health District for a permit to const uct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__-••"-- ---------- <br /> Address <br /> '------------ <br /> Phone <br /> ----- <br /> F . <br /> Phone.---- -- ....-...-_-.-_-.-.-.-.-.-.-.-.-.-.-_-_- <br /> Owner's Name ----- ----- - <br /> Address----- -- - -------- <br /> ._....._ ----------------------------------------------- <br /> ---------------. -------------- <br /> 7 , <br /> Phone <br /> Contractor's Name_../ <br /> Installation <br /> will serve:. Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --I.... Number of bedrooms _r4-.. Number of baths ._�..�. Lot size _.. 'r: ~�------------------------ <br /> Water Supply: Public System X Community system ❑ Private'❑ Depth to Water'Table tp._ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 135 Clay Loam ❑ Clay ❑ Adobe❑ . Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No ® _ <br /> TYPEIOF INSTALLATION AND SPECIFICATIONS- <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> -- Material ` <br /> Septic Tank: �Distance from nearest well"�ao0""__Distance from foundation - - -- <br /> No. of compartments----c ------------- --..Size. _ ' ----- ----Liquid depth .3' ----Capacity-A ---. ----- �3, <br /> v <br /> Disposal Field: Distance from nearest welk.. .,;_ x..Distance from foundation_.._3 .........Qistance to nearest lot line.- _ ......... <br /> is ® Number of lines-------------- ------ --�-L gth of each line---------- .........-- --------Width of trench------ ------- .-.. -------- 0 <br /> Type of filter material 'epth of filter material-- ,. 1y- Total long#h.-.--.I.T................"____-----. <br /> Seepage Pit: Distance to nearest welL.-..------------------Distance from foundation..............:....Distance to nearest lot line.........._....._ <br /> ❑ Number of pits--------- ------------Lining material--------------------..Size: Diameter- --------------------Depth--------------------------------- r <br /> Cesspool: Distance.from nearest well-----------------Distance from foundation--------------------Lining material-------------------.------.-._-.----. <br /> ❑ Size: Diameter------ -------------------- ----------Depth----------------------------- ------"Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------------- Distance from nearest building-------------- .-------.__-_.-.--.-.------ <br /> Distanceto nearest lot line--------------- ----- --------------------------------------------------------- -------------- ------------ -------- ------------------ <br /> Remodeling and/or repairing (describe)-------- ------------ ------"------....--------•--------------------------•----------- ---­------------------------- ----- -.---- <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 /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> [Signed}rn. '4-- �'b'2' '----f (Owner and/or Contractor) <br /> By----------------------------------------------------•------ ----- ------- <br /> -0—(Plot- <br /> ----- = )Title) <br /> " (Plot plan-"showing size of-lot,-location-`of-system in relation to'wells,-buildings,".atc:,-can=be placed`on�rever5e-side).��7 =� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.. -- <br /> DATE.. ." -' ------------ <br /> REVIEWEDBY------------------------- -------------- ----------------------------------------- --- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------- ---- • DATE--------------------------------- -------------------•--- -- <br /> Alterations and/or recommenda#ions:-- ---------- - ------ --------- ------- ---------•-----------------1_____r-------------------------------•------------=•--------------• ------------------ <br /> - - <br /> -------------- --------------------------------------.-...-------------------------........ .,. <br /> -----•---------•---------------------- ------------------------------------------------------- -- <br /> ------------ ---------------------------------- ---------- ---- ------------------------------------------------ <br /> FINAL INSPECTION BY- . ........ .... . .. --------------------- . <br /> Date" _ �/ - cam --------------------- <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�J' 145446 ATWUDD <br />