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, � Permit No. APPLICATION FOR SANITATION PERMIT --.. -- (Complete in Duplicates Data Issued (_ -e/----3 I in Local Health District for a permit to construct and install the work herein des Application is hereby described. made to the San Joaquin This application is made in compliance with County Ordinance No. 549- _�3 JOB ADDRESS AND LOCATION---------14----/---��--------------------- ' /-- ---� -- F7►` = _ _ Phone.----------------------------------- Owner's Name_____ j ��-�„�-•.._--•---- Address DQ ------------------------------------ 4_4-- -- a�c�1-----Of-6/��-----i��_ �-----------'T a /p / o-- Contractor's Na --.---- _ --- - - ------------------------------------------- --- - Commercial Trailer Court ❑ Motel ❑ Other ❑ Installa+ion will serve: Residence Apartment House ❑ ❑ n ®�,p e Number of I•iving units: -__ Number of bedrooms Number of baths _-_---- Lot size f� �/ Water Supply: Public system Community system El Private [I Depth to Water Table -------- ft. Adobe Hard an Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ � p C1 Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ NON TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is ava within 2f30 feet.) f Distance rom foundation__-, Q_------Material_____ F Septic Tank: Distance from nearest well • .Q__-_-- • Nn. of compartments---- ----- --Size-� _ s� squid depth.S_ ----- _--t,47- y- � �y s Distance from foundation_��/- ----Distance to �ir�e_ Disposal Field: Distance from nearest well_-- --, Width of trench.-*"------------ Len Length of each line 0 �!- Number of lines____��A��-- --- 9 • Type of filter material__�_�.:__9Q��Depth of filter material----1�--. --� -----Total length--- -0------- 7 It ----Distance from foundation___ _�_-.-.-- jistance to nearesfi�tlhne__A' ---- Seepage Pit: Distance to nearest wed I --g ----_---__Depth. KNumber of pits___ _ ______ ___ intim mater ial_-B -i_�'/�S}ze: Diameter___ Cesspool: Distance from nearest well-----------------Distance from foundation__--________------_Lining material_..________.__________-____-_-____.__ ❑ Size: Diameter----------- ' --------Depth------ ..................... ----A----- ----- Liquid Capacity gals. Distance from nearest well---------------.---------------------------------Distance from nearest building---------------------------------------- ----------------------- - ------------------ -------------------------- ❑ Distance to`nearest lot li ------ --------- ---------------------------------- --------- - --------•------••----------- --- = - Rodeling and/or repairing (describe):_-- -- - ----------- ---------- ---------------------- em -------------- -------- -------------------------------------- ----------------------------------------------------------•------------------------------------------------------------------- I hereby cert'f that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, d rules an4_regul ions of the San Joaquin Local Health District. 5i ned _ ------- ------------------- - ______________ ___(Owner and/or Contractor] ( 9 ) f� n � � --------- - �_ ------ -- ------(Title)------- - -- - - ----------- ---- By:...(Plot plan, showing size o rot, location of system in relwells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- - - - -- -------- ------------------ - DATE------ r ----------------- ------------ - -------------------- DATE----------------------------------------- --------------- REVIEWEDBY--------------------------------------------------------- ------ - DATE----- -------------------- ---------------------------------- BUILDING ----------------- BUILDING PERMIT ISSUED---------------- . ------------------•--- -•---------------••----------------•-------•------------- Alterations and/or:recommendations----------------- ------------------------ --- ---------------------------- ------------------- -------- ----------------------- ----- t Date---------------------- - 5--1---�---�-------- FINAL INSPECTION BY-------------- ---- -•-- ---- ------ AN JOAQUIN LOCAL HEALTH DISTRICT 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Stree4 Trac California Stockton, California Lodi. California Manteca, California y. E5-9-2M 10-52 Revised W-2100 _