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i APPLICATION FOR SANITATION PERMIT Permit No. ---"- (Complete in Duplicate) Date Issued _____ Applica;ion is hereby made to the San Joaquin Local Health District for a-permit to construct and install the work herein described. Ordinance No. 549. 1 JOB ADDRESS AND OCATION___ - _' This application �s made in compliance with County f ------------------- Owner's Name ---I.... ��.�� . = --------------------------------------------- Phone-------------------------------- ----------- Address-------- ems= = � k" •- �3 . --------------------------------------------------------------------------------------------- Contractor`s Name.. -. _"----------------------- Phone ---- --------------- F Installation will serve: Reside cfe Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __[-'""_ umber of bedrooms __vNumber of baths .__)___ Lot size ------ ------------------------- Water -___"-___"-___"-___Water Supply: Public system ❑ Communit1 11—y system ❑ Private � Depth to Water Table __�h . Character of soil to a depth of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam ❑ , Clay Loam Clay 11Adobe 4I Hardpan ❑ Previous Application Made: Yes ❑ No New Consfruction: Yes No ❑ 9 TYPE OF INSTALLATION AND SPECIFICATIONS: o septic nk or cesspool permitted if public s er is available within-200 feet.) S tic Tank: stance'from'nearest well-_. "�� -__Distant -fro .foundation--k13 :± _- aterial __ :1` 1 No. of compartments....... ._. __ SSize___��_� . �, _ Liqui de ------.___ ---. _Capacity. _�!?lz_..___ sal, Fiel Distance from nearest we€I__ V-- _< Distance from foundation........ .. ....Distance to nearest lot li .e.-_ .. Number of lines__________ _____ __ -----_____ -Length of each line--_-._-_/_ ___ __- -.".Width of french-----" -__�.__________---------- er materia! ------------- --Depth of filter material--" _ --'9-__ ----Total length-------- _°' . "-___---_._--.-_- See a e Pit: Distance to nearest well.... ___""_Distance from oundati _ ,_,Q.....___DDistanc to nearest lot lin Number of its------ --------------Linin material:_ i Diameter________.. _ -__.Depth..._. __ ____________. Cesspool: Distance from nearest well-----------------Distance from foundation-----K-------------Lining material _____------- .-.,_..---.-__"--______ Size: Diameter--------------------------------------Depth------------------------------ __-- _ .Li ui.d Ca acit Pls. -- --.--- Privy: Distance from nearest well_._.._-._-en---""""-"--____---___---,__"-._.._Distance from nearest building--------------------------------------- ❑ Distance tonealesf lot line-- -- --.-- :-____-- f -- Irj ,, -------------------------_- --------------------------------------------•- ------------------ • r - galr --- "T - ----------- - ----- --- Re el' / rb -------- ------ ---- � - -- - --- - - ---------------------------------------------- ------••---------------------- --------- . - x "__-.._-__"_-"-________.__.___"------------ --"".."-___"_""_-_""""_-__"_"""__-"____"-"-.-.__._...»__•_"_"_-__....--.._-....-.._."""."_""_"_._""""""_"-__"_"----_""-"-"."""""___""...__""."_"-.--_-..__ __.---_-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local„Health District. (Signed) `'� ��P.r --------------- --'£-.-•--- ------.(Owner and/or Contractor) By:-----------------------=---- -----------------------------------------------=---------------=-- -- •------•---•-------•----(Title)-=-----•------------ •--•------------------------ (Plot plan, showing,size of lot, location of system in relation to wells.-6uildings, etc., can be.placed on reverse side). T` ' f FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------- -'----- -;------------ DATE------------•-----------•---------------- ------- i REVIEWEDBY--------------------------------------=------ -------:--'-'-----'='-- ' � -- �-�--------------------------- DATE-----------�_f-�_�-------�---------------- BUILDING PERMIT ISSUED------------•----------------------- == = ' /[/r�A DATE. %_ Alterations and/or recommendations:.____...____:..._. "”` _-- ~ -------------------------------------•---------------------------------- -----------=--------------------- ---------•-•--------------------------------------------------•--------------------- •----••--------------•--- .__.-..-.---------------------.------+---------------------...--------------------------------------------------------------------------- b _...______.______________.____...___._...____.____._._._.______._ I .:., �' -------------- -- -------------------------------------------------------- FINAL`S INSPECTION BY:............. .. . Date----------2--- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 0A Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E`- 9-2M 345446 ATW000 12-54