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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) vDate Issued ,5-1,6 yS 7- - 7------ A �plica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and in work herein described. This application is made in compliance wit Count Qrdinance No. 549. JI JOB ADDRESS AND LOCATT)JON - -------- ------ -- --- ---- --- --- _._*--- --------- -- ------- Owner's Name------- ------------- -- ---- ----------------------- -------------- Phone- x ' Address---- -3 V-- - ----------------------------------------------- Contractor's Name------------- -- ------ -----------------------------1------------- ----------- Phone Installation will serve: R si encs Apartment Court [0 Motel Apartment House E] Commercial 0 Trailer Cj Motel Other E] Number of living nits: _/---- Number of bedrooms,---0,__._ Number of baths _/__ Lot size --------------------- Water Supply: Public system Ej Community system E] Priva t5K Depth to Water Table 7-4/-ftoirft. Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam Ej Clay Loam El Clay .Adobe Ej Hardpan E] Previous Application Made: Yes F] NOW New Construction: Yes No F-l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tek: Distance from nearesf well-----------------Distance from foundation--------------------Material ---------------- -0 No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity---------------------- q 4 Fi - �'i_ Disposal t� Distance from nearest well------ ----------Distance from foundation-----------------_Distance to nearest lot line-__--__---------- - G. Number o{ lines------------------ ----------------Length of each line----------------------------- Width of trench--------------- Type of filter material------ -- ----------- -----Depth of filter material----------- --------Total length------------------------------------------- S3e)pae Pit: Distance' to nearest well-- ,,.,---------------Distance f1porn joeclafion_---/4-1.....Distance to nearest lot line---- Number of pits--- Diameter___ ,-_-_--_-_-- -------- -------------Lining mater 4----Size: D ia mete ---------Depth-----_.,7a---I----------- Gess P_ Distance from nearest well-----------------Distance from foundation - _---------__Lining material___._----__._--..-_____-_ - 1-71 Size: Diameter-------------------------------------Depth--------------------------------------------------.-Liquid Capacity------------------ --------- Privy: Distance from nearest weli-,----------------------------------------------Distance from nearest building__-__-----.____----__----_-___._-____----. ❑ uilding------------------------------------------ 0 Distance to nearest lot line . Remodeling and a,ri �_•___ Remodeling and airi -escri ---- -- --- be): ---- - ------- - - - ------ ------------------ ------------------------------------------- ---------------------------------------------- - ------�/_ - ----------------- ----- ---- !-- ----------------------------------------------------------------------------- ------------------------------------------------------------;-------------------------------------------------------- --- ----Xer-eby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou fy 0�1 ordinances State la and rulenid?,egulatio!js_of. the San Joaquin Local Health District. Owl ----------- ------------------------------------------------------- (Signed)-------------- ------- --- -------- - --- ---Owner and/gr Qmtractor) B, -----_---------_-------------- t ------------- (Title) - .?�rpir --- ------------ -------- --------------------- ------------ ---- ion of s ern in relation 0 wells, buildings, etc., can be p ,4� on reverse sido, ----- ----- I--- ------------.1, ----------------------------- .0 �V (Plot plan, showing size of lot, location FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------- ----------------------_--- DATE--------q_= REVIEWED BY ------------------ ------------------------I------- DATE----------------- ------------- I G ATE-----------------ING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterationsand/or recommendations:-------._____---_-___--------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- --------------------------------------------------------- ------------- ------------------------------------------------------------------------------------------------------------------------------------- ---------------_....------------------------------------------------I----------------I-----------------------------------------------------------------------------------------I------------------------------------- --------------------------------------- ---------------------------------------- -------------------------------------------------------------------------------------------------- I- --------------------------------------- FINAL INSPECTION BY:.__. '' ----------- --2--- Date-------- =—?-�....25_y............................... SAN JOAQUIN LOCAL HEALTH-DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Straot Stockton, California Lodi, California Manteca, California Tracy, California ES-9-4,M Revised W-2100