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�Iq1� APPLICATION FOR SANITATION PERMIT Permit N°- S -`- (Complete in Duplicate) Date Issued I- -� ------------ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her in described. This application is made in compliance with County Ordinance No. 549 �,. .-- JOB ADDRESS AND ATI N___ ---- i I Owner's Name----------- ---- - ,f . ..". ..... ----------- ---.------------------------ Phone- - — - ! ; G ---------------------- -------- Contractor's --- 3 ' ' ...�� ,... � Contractor s Name-------- �d""-- -- - --•-------•------- - - ---- -------- Phone--- `�"-------------- Address -- Installation will serve: 'Residence Apartment House E1.1 Commercial E] Trailer Court ❑� Motel E] Other ❑ Number of living units: . '"" Number of bedrooms _. Nurii6er of baths " Lot size f""""-- ---.- � ---- Water Supply: Public system Comm pity system-❑ 'Private ❑ Depth toater Table Character of soil to a depth of 3 feet]. Sand Gravel ❑ Sandy Loam Ial Loam ❑ Clay ❑ Adobe Hardpan ❑ s Application Made: Yes ❑ No RNew Construction: Yes No ❑ 1 Previau PP � p ` TYPE OF INSTALLATION AND SPEClFICi4TIONS: ) ( p .. ! Se t[c T Distance from ne permitted if public,sewer is available within 240 feet.) No septic tank'or cesspool per _ € , ' �' ! ' - rest well: . - Distance,from *'>,_e ound tion_- �Q____ Mat rial-__.�<�'-- _------- --.-- I p . � eg No. of compartments= ------- -----size.+ ._X_------ Liquid depth a Capacity-..,/-x -- r � ----- Disp sal Field: Distance from nejrest well-------------------D.istance from foundation...................Distance to nearest lot line.......--..._.._ + /2o' Number,f-fines------_---------------------------Length of each line----------------- /------,.Wid_th of trench----------------------------------- -rt- ------------------------------ -- '` - r Total length - See a it: 4 Distance to nearest well-.. /-_.....___. -_D st ce from foundation....__-J.�.__.........Distance to nearest lot line.-.f...--...... Type.'ot'filter material-------------------------D'e th o e m Lena.-_- p $ Depth s� 1� Number of pits.----�'-�------=-----Lining rria erisl. - ----s --_"_-- ---Sa.e: Di meter._".-- -- 1 f Cesspool: Distance from nearest well ---- Dist ce rom f° dation.__- Linkng material__.--------------------------------- m ❑ Size: Diameter ----------- -----------Dept' --------------,, ----------------- -------------Liquid Capacity--- -----------------gals. r � Privy:' Distance from nearest well------------ '_ "..._Distance from nearestbuilding.--"".------------------------------------ -------------------- -. Y , S ---- ---------- ❑ Distance'to nearest lot line r -- --°----------- ----`----..-------------k---------------- and/or repairing (destribe�: :f: --------------------------------------------- --------- Remodeling dp - ------------------------------------ ------------- } .. t --w—• - -------------------------•------ ------------- • i" prepared this application and that the work will be done in accordance I hereby certify that I have prepa pp h- dance with San Joaquin County ordinances, State laws, and rules and re uulations-of'the-'San'Joagoiin L`acal Health-Disttidt' ' �rrr y ------------------------------------- - ___________ _ ___(Ow er and/or Contractor] (Signed)---- .. - By:---------------------------- '�-��; �u.�" ---------------(Title)- ' ------ - (Plot plan, showing size of lot, location af.system irk( tion to wells,'buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY --------------- DATE-------------- APPLICATION ACCEPTED BY t --L�----- - REVIEWEDBY DATE----------------•------=------------•--------------------- 1 BUILDING PERMIT ISSUED------•--------------------- -----=----- DATE Alterations and/or recommendations------------------ -----------"---------------------•-------------•••--------•--- ---------------------------------------------------------------- 1 ••--- ----------- ----•---------------•--------------------=---------- --------------------------- --- --------------------------- - --- [ V qFINAL INSPECTION-BY:: � ,( .,� . Date--. _4-- -------- - -----------------------:------------------ r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Revised W-2100