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S1O II APPLICATION FOR SANITATION PERMIT Permit No. (C...... +, {Complete in Duplicate} lj Date Issued ________________ _____ Applica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. p JOB;ADDRESS AND, -------- 1--26`.'--`--'-- - T� M_ el�----------------------------------------------•-----1--------- .----------------.._ Owner's Name--------- ------•--- ---------------- ----- ---- •-•----------------------------------- ------------------------- ----- Phone-----------------------------------.- -D Address------------------ — =----- r Contractor's Name -------��---k---17----- Phone -- -- - ----------------=-------------------- - Installation will serve:_ Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Othe. ❑ Number of living units: ____.___ Number of bedrooms ___Number of baths ____'r_ Lot size ---/�_ ------- .___________.._---- Water Supply: Public system-:❑ , Community system ❑ 'Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [g,-Idardpan ❑ Previous Application Made: Yes ❑ No ew Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:1 [No 5sptia tankorcesspool permitted if public sewer is available within 200 feet.} Distance-from nearest well-.;--------------Distance from foundation--------------------Material_______.___.__.__.____-_---______.__._.________- i No. of compartments--------------------------Size------------------------•-- :Liquid depth -----------------------Capacity----- ---------------- posal ' - Distance from nearest well...•��.___Distance from foundation____0..__....Distance to nearest lot line�j______________ �1 Number of lines------/---_ .._. _-_Length of each line---�..�--- _-------------Width of trench-----e-_ _.__.__.._ .............. Type of filter material-- f p ft Total length------ _._ �.��__.Depth of filter.materiaL_��..._.._. _ _______._ � Seepage Pit: Distance to nearest well _____________________Distance from foundation__..._____.._______.Distance to nearest lot line________________ ❑ Number of pits.._._°----------------Lin•sng material---------------------.-Size: Diameter----•------------------,Depth................................. Cesspool: Distance from nearest well�4y____-----Distance from foundation------------------- Lining material__.__.___________._:____.___-- ❑ Size: Diameter---- - ---------- ------- - ----Depth----------------------------------------------------Liquid Capacity_--------------------------gals. � Priv Distance from nearest well.....-___---------------------------------------Distance from nearest building ❑ Distance to nearest lot line----__---_--------------- Remodeling and/or repairing (describe�:---------------------------------------------------------------•-----------•---•------ --------------I ----------------------- ------------•-------------------------------------------------- -•-------•----------------------------•----•------------------------------•-----...-.-.-.------------------------------------•----------•-•-•---- ---- - -----------------•-------------------------------------------------•----_-----------_---__-_-----••-•----•----•-----------------------•----•----------------- 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. D"&NIGHT [Signed} g Tarr S2rvic+a .. )4w rad � Contractor} BY:--- -- 1206 So.Eldorado HO 2-7446 � [Plot plan, shows ae of lot, Ioc �Pol�t4y�'I 'in relation +o w Is, buildings,:et ., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 4 ---------- -----------------------•----------------------------------- DATE-=-._. REVIEWED 13Y - - -- --- ---------------------------------------------._ DATE ----•------------ BUILDING PERMIT ISSUED---------- ----------------- ----------------------------•----------------------------------------- DATE----- " . v Alterations and/or recommendations:------------ - --------- - = ---------------------------------------------------•----- -------------•---•------------------------------------ \i -------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------•-------------•----------------------•--•---------- --------------------------------------------------------------------------------------- FINAL INSPECTION BY:---- �--------- ---------------- Date----- �" ( .� � ._._ 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 E5-9-2M 145446 wrw000 12-s4