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;APPLICATION FOR SANITATION PERMIT Permit No. ' (Complete in Duplicate) - Date Issued _ ------ ° Applical-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 compliance with County Ordinance No. 549. u �G JOB ADDRESSLOCATON--�-otc- '----- l _S.-- - - J Owner's Name-- ----- rhe-4-h-e-S-----C16---------------------------------------------------------r Phone Address-------------- tn G � ,--G--J--�------•.--------- f�__--------------•------ Contractor's Name--------------------------- ------------------------ - ------ PhoneQ Installation will serve: 'Res-idence ❑ Apartment House-E] Commercial ❑ Trailer Court ❑ otel ❑ Other _ -� Number of living units: --------- Number of bedrooms ------._ Number of baths ________ Lot size Water Supply: Public:system ❑ Community system ❑ Private AK Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand Gravel 1 p ❑ ❑ Sandy Loam Clay°Loam ❑ Clay ❑ Adobe � Hardpan ❑ Previous Application Made: Yeses No ❑ New Construction: Yes ❑ No ❑ ' ..r, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tankor cesspool permifted if public sewer .is available within 200 feet.) ^ , LV ' Liquid depth ---------Capacity-------------- - tic,Ta Distance from nearest weft-----------------Distance from foundation__.___-________-. _.Material_________ -_ _ __. _ No. of compartments__'------- ----- ----Size-------•----•--- ==- D offal ie�d: Distance from nearest well__ __ _________Distance from foundation_----___________--.Distance to nearest lot line.__-____-________ -D Yupm&er of lines-----------1------------------r Length of each line_-----------------------------Width of trench---------------------------=-_--- i Type of filter material______________ -------Depth of filter material--------------- --------Total length------..-___:__.._________------__-_-_--, e Pit: Distance to nearest well-/V&---------Distance fr f ndation-.f _.__..Di to ce to nearest lot �` See a Number of pits - == Lining material^ es ,+ `i Size: Diameter--- ---- - F Depfh.c -------------- 0 Cesspool• Distance from nearest-well--------------___Distance from foundation______-________-__.'Lining material---__.._________-___________ ----- Size: Diameter------------------- -------f --------Depth--------------------I------------------------- -Liquid Capacit - -- Y----------=-----------------gals. Privy: Distancefrom nearest well------------------------------ ----------- ------Distance-from nearest buifdirig.-______------ --------_-- ❑ Distance to nearest lot line A. Remodeling a d/ repairing (describe):--t_-b-4-----.- MD-f-r' i 4�Rll_ i'i�E? E 'R� Ar" ------------------------------ --------------------------- a ------------------------------------------------------- -•------------------- -----------------------------------------------------------------------------------------------------------------------------=---------------- I herily ce fify that I have prepared this application and that the work will be done in accordance with San Joaquin County • ordinancesta laws, andsrules and regidaflo" of the San Joaquin Local Health District. (Signed) #J- a ------- --�----- - -- - - -•------------------------- ------- -{ i Contractor) ---------- BY:--------------- `... (Title)--- (Plot Title_ ( 1 1 07h) Contractor) - (Plot plan, showing size of lot, location of system in rel i n fo wells, buildin , etc., can be placed on reverse side). • " FOR EPARTMENT USE ONLY; I APPLICATION ACCEPTED BY -------------------------------------------- DATE-----------�� • REVIEWEDBY------------------------------------------------------------------------------------------------------------- "------------- DATE ------•----------•-:-•---------------- BUILDING PERMIT ISSUED------- -------------------------------------------------------------------------------- ' -------_. DATE - Alterations and/or recommendations:------------------------ ----------------------------•---------------- '* ----------------------------------------------------•---------------------- - ----------------------------- ------------------ - ------------------------- ----------_------------------------_----------------------•-----------------.-------.--------__---------------.---------------------------------------.___.____.________._ FINAL INSPECTION BY:.- == ------------=--------------------= Date-------LL = .SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sheet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-1-2M Revised W-2160