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L� 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. This application is made in compliant with County Ordinance No. 549. JOB ADDRESS AN R5 LOCATION.___ -----------t' �` ��`� t �� ---- ---------- -- Phone--------"--- ---------------••- Address_�• 4_,P-___ - _45.'-------- n J4 ` ............... -----•-------------•- Contractor's Name----------------------------- -�__ �----------- - �!p 0 --- -------------------------------------- Phone---_----.---- Y-4.---� Installation will serve: Resi ence JK Apartment House ❑ Commercial 04 Trailer Court p Motel ❑ Other ❑ Number of living units: ----/-- Number of bedrooms -__YNumber of baths y__ Lot size ____S!�p' 6,fi-" ----- - ------------------------------- Wafer Supply: Public system ❑ Community system 14 Private ❑ Depth to Water Table _ *_ ft-r/4(9 Character of soil to a depth of 3 feet: Sand Cl- Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobej& Hardpan Previous Application Made: Yesk No ❑ New Construction: Yes ❑ No ❑ N TYPE OF INSTALLATION AND SPECIFICATIONS: '" '" " (No selstic tank o#—e3poot permitted-if public sewer is available within 200'feef.) _"" ' Y - Str tic T s Distance from nearest well__"" __________Distance from #oundation__________----- ----Material ________________________________.- . _- L-y No. of compartments---------- ,,tSize------------------- ------Liquid depth--------------------------Capacity osal Distance from nearest well__��. '~_Distance from faun ation___� Q _.__Distance to nearest lot line.__ -------- 2 - ,�� Number of lines____ ___ �r 4A r"�E--- ------ Length of each lin -.Width of trench.__1 -------- - ----- --- E Type of filter material.- _____ _________Depth of filter mater�1 __ Total length �. 0 --------------------- p p a t: Distance'to nearest well '�O.1 stanc m f undation-- stance to nearest lot fine_____ - .,. Il d Number of pits----- Lining material___ _-____ __--Size: Diameter___-"-_ i _ Depth �o----------------------- Cesspool: Distance from nearest well________________Distance from foundation_ Lining material'______________________ ___________I ❑ Size: Diameter------------------ ------- - ----Depth-------------------- -------- ------------ ------Liquid Capacity----- ------•----•----------gafs� Privy: Distance from nearest well------------------------------------------------- - f ` ______________"__-________-""_-Distance from .nearest building .•� ❑ Distance to nearest lot line----------------------------------------------------_- RemodeNn and/or repairing ___ .-"-_"-_ ` ` QQ r"4 -- ------------------------ - -------------•--------------•----••------ - -------•------------•----------•-----•-------------•----•------•---•-----------------------•---------------••-----•-----•------•-----------•--------------•----•--------------------------------------- ----- ------ 1 I hereby erti y-that I have pre ed this a plication and that the work will be done in accordance with San Joaquin Coun ordinances, ws, and ruhs and gulation of the San Joaquin Local Health District. (Signed)--------- ---------Pr 4 g - - Y• = = -{Title) d.. 8 �' Contract or) :, . {Plot plan, showing size of to}, location of system iLiis Ings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•----------------- _- - --- DATE------ --- --- REV IEWED BY DATE---------- BUILDING PERMIT ISSUED_ ----=---------------------------- -------------- - -------='-------------------- ------------------- -¢. - -- DATE.----------Alterations and/or reco m dations:--------------------------------- •---------------------------- ---- -------•----- •----- ---- ----------- - ---- -------------- ------ ----------------------------- •----- • --- .---- ---- FINAL INSPECTIO� $Y-------------- --- ------ ate------ - ---------- ---------- --------j(-�-3-��-�-----� -------- 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 ES-9-2M Revised W-2100 �