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APPLICATION FOR SANITATION PERMIT Permit No. ----- <br /> (Complete in Duplicate) <br /> Date Issued ---- <br /> plica-�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with f-ounty Ordinance No. 549. Q E.",t <br /> .. <br /> JOB ADDRESS AND LOCATION-... <br /> ... 4r <br /> i <br /> Owner's Name------ ---------------------------- ---------------- - - ------- ------------------ ...... <br /> Phone <br /> Address-------------:n-- ------------------ <br /> ------------------------- ----------*------------- ----------------------------------------------------- <br /> � ----------- <br /> Contractor's Name--------------- et!7�_-.6 k ---------- ------- Phone----••-1 - .300--C, <br /> Installation <br /> hone-------Installation will serve: Residence Er'lAparfi-rient House E] Commercial E] Trailer Court E] Motel Ej Other El <br /> Number of living units: _/.. Number of bedrooms -.2.- Number of baths ---/_ Lot size -_'_-----_--______----- <br /> Water Supply: Public system F1 Community system 0 Private gq-Depth to Water Tablede ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam R]- lay Loam El Clay El Adobe El Hardpan El <br /> Previous Application Made: Yes E] No 8' New Construction: Yes @a-No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> A <br /> CArl". _, <br /> Septic Tank: Distance from nearest well---- Distance from fpundafion----le------Material___C__,��----- ------------------- <br /> No. of compartments-----.------------4-_Size__-40. X_f_0------Liquid depth----- x--------___Capacity---- <br /> --Capacity---- <br /> D;sposal Field: D;sfance from nearest we�l_4- _-Distance from foundation-----?-e <br /> -------------Distance to nearest lot line--- <br /> or i th <br /> Number 1 lines---_____--_-/-----------------/?Length of each line_-__--- '__.-------.-.Width <br /> --------.-.Wd of trench------- -9---.--_--_---_._ <br /> - ---- <br /> _1A- -I _4----.Type of filter material._ of filter material------/ -Total length----------/4------------------------- <br /> Seepage Pit: Distance to nearest well...--.-.--------------Distance from foundation--------------------Distance to nearest lot line---------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter----------------_-----.Depth----------------------------_.--- <br /> Cesspool: <br /> ep6-- ------------------------------ <br /> Cesspool: Distance from nearest well__-__---_-__-_-_Distance from foundation-------------__Lining material--.-__--__-_------------------------. <br /> Size; Diameter---- - ---------- ------- ------ ----Depth----------------------------------------------------Liquid Capacity---------------- ----------gals. <br /> Privy: Distance from rearest well-------------------------------------------------Distance from nearest building.----- ------------------------------❑ ----- <br /> Distance to nearest lot line------------------------------------- -----------------------­----- ------------------------- -------------- <br /> Remodeling and/or repairing (describe):-------- Or-------------------_-------------------------------------------------------_----------------- <br /> ............................................ --------------------------------------------------------/Z---------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------- --------------------------------------------------------I-----------­-­-----­-------------------I--------------------------------------------------------------------------------- <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)........ w -•--1-� ----------------------1- --------- ---------------------(Owasv--sm %T Contractor] <br /> By:-------------------------- -- ---- -----------1-r---------------------------(fie)' ----- ------------------ <br /> (Plot plan, showing size,,, of system in relation to wells, buildings, etc., can be placed on revervside).---- <br /> .FOR DEPARTMENT USE ONLY <br /> ZP_ <br /> APPLICATION ACCEPTED BY - ------ - - --------------- DATE. <br /> REVIEWEDBY----------- _�__ ----------I------------------------------------------ <br /> BY--------------------------------- ------- ------------------------- --------------------------------------------- DATE..T------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-------- ------------- ---------- ----------------------------------------------------- DATE--------—----------------------------------------------- <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------- ­------------------------ --------- ---------- -----------------------------­­--------------------------------------------------------------------------------------------- <br /> ------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------------------------------------- <br /> ------------------------------------------------ ---------------------- - -- ------ ------------ ------------------ ------------------- ------------------------------------ -----------------------­-- <br /> ---------------------------------------------------------...... 7 --------------­ -­ --------I--------------------------------------------------------- ---------------- ---------------- ----------------------- <br /> FINAL INSPECT-11ONVY:---------5, ------------------- -------------------- - Date. . , # ------------•--------------------- <br /> SAN <br /> ate- ---------------------------------- <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 /> E5-9-2M 145446 ATW DOD 12-5q <br /> J <br />