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APPLICATION FOR SANITATION PERMIT Permit No. _11).R' 4L (Complete in Duplicate) u bate Issued ___,�/� Application 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. S49. ' A JOB ADDRESS AND•L ATION------� -------------- f)J4_k:l_...... ----- ©+� Owner's Name-------- --- - --------------------=- -------- Phone Address----------------_-'--- ------ t ---- ----- ----------------------- � r , x Contractors Blame___ __. .. ---•:--�-/-------�� _�1�/��---- - -------------------------------------------- one----.:.------------- -----_------ Installation will serve: Residence ❑ Apartment House ❑ "Commercial " Trades Court '❑ Motel El Other � �2�/� Number of living units: __..,'_ Number of bedrooms -------- Num er o at s ____--__ Lot srce ____�_____✓____-.X__ ___________________________ t Water Supply: Public system [,1>mmunity system ❑ Private ❑ Depth to Water Tablet. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [❑ ij Previous Application Made: !Yes ❑ No F/ New Construction: Yes ❑ No Lg' FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public wer s .vai&ble within feet.) _ �4 Septic,Ti nk: Disfance from nearest,.weii` - ____ istance from fo} ion___ Mate �I__ .___: :_____ [✓j No. of compartments-*-'----__Z-�_ .,-_-Wisa ''_ h-- >_Liquid dep ---_--r .-------.-Capacity._. r _ F. , fromfoundation_'/'_-______._.Distance to nearest lot line__.D+spos I.l field: Distancefrom nearest we _-,._____ Q Number:of lines___- --. --- Length of each line=______> ___,-]��_--Width of trench.__-cc:;y_�__----_____________ .a Type of filter materials D of filter material �CJ�- Total length t=+Ec " = See�ge Pit: Distance,to nearest w ll_ ____.____:--- istance f f, ndation___!`- ---------Distanep to nearest lot line__ �--- Number of pits_______ _______ ___ g Linin materia{__1__ Y� Size: Diameter____�n3-----------Depth__._______________ Cesspool: Distance from nearest well--------_--------Distance from foundation---------------.-----Lining material_______________-____.________________ u ❑ Size: Diameter-------------------------------------'Dept h------------------------------------------- . ---Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________________________________________ ❑ Distance to nearest lot line----------------------------- --------------------------`------------------------------------------------------------------------------------ �. Remodeling and/or repairing {describe}: ------- -------- ------ ------ --------- -----� _.. r --------��----------f� P. '-4(fi j ZE , lis sY5 ------ ---------------------- A F -----------------------------------------------------••---------------- ------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ces, State laws, a )d"rules and reg lations of the n Joaquin Local Health District, ordinances, `--(Owner and/or Contractor) (Signed)-------------------------�--- ------------------------------- - ------------ --------------------------------------- ---------------------- i - t By:--------- - �--:.....- ------- �,.�-��--- -- -- - - -�--- - --- - �-{Tit{e)----------------------------- ------- -- ---------------- (Plot plan, showing size o lot, location of stem in relation oo wel�bu ings, etc., can be placed on reverse side). ! FOR DEPARTMENT USE ONLY } t APPLICATION ACCEPTED:BY____-_-- / -- DATE--- -.___ _� .: ---- - - ----------- REVIEWED BY-------- DATE ----- ------------- f BUILDINGPERMIT ISSUED-'----------------------------- --- ----------------------------- ------ DATC------------------------- --------------------------------- Alterationsan recommends o s: -------------------- ----------------------------------------------------------------•--••-•--------------------------------------•--•----- ,�}f� ----------- ---------------- GSL ------------ �, -- --------- - - ---------- ------------------- ,----- --- =_= ' . ------------ FINAL INSPECTION BY -- -- --- -- ----- e --------- --- -- ------------------- � Date---------- ��•---/��_.��-U----------------- ---------- ----- ; SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street. 300 West Oak'Street,y ' 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California y ' ES-9-2M , Revises 1.57 F.P.CO.