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Permit No. _._Oel--------------- APPLICATION FOR SANITATION PERMIT _(complete-in Duplicate) - Date issued =� ^ ibed. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descr This application>is;made in compliance with County Ordinance No. 549. ., """"".�+.+`► JOB ADDRESS ANyDiLOCA TION=-------- „2 -+ �' Phone ------------•------------- Owner's Name--------- -- S.YJ✓� - --•----------------•-•----- Address--------------- ------------------ i w----------- ----------- Phone-----------------•-----•---------- Contractors Name_.=_-------•�----------------------------------------" "- - " Commercial ❑ Trailer Court ❑ Motel ❑ Other �`' A ar'tmen#"House ❑ Installation will serve: Residence ® p -- Number of living units: --__--"_ Number of bedrooms ____•Number of baths __1----- Lot size ._-_:_�---- -- -------•- i Communit s stem ❑ Private ❑ Depth to Water Table --____-_ ft. Water Supply: Public Iystem Y Y dy Loam E1 Clay Loam ❑ Clay [3 Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 San � t New Construction: Yes No F1Previous Application Made: Yes ❑ NoA } TYPE OF INSTALLAT16-M AND SPECIFICATIONS:c sewer is available within 200 feet.) (No septic tank or'cesspool p p I t - _-_ nearesT we}; � � - idMaterial_"--_.-_-"- __ - _ _ � foundation Tank: Distance from ___ .r Liquid apth-------- -------. Capacity - -•---��--------- +� Nol of compartments----------- --- -----Size---_- ------ P "-,Distance to nearest lot line------- ------ Field: Distance,.from nearest well- - --_Dista h ofreach line foundation-- 40, j�-----Width of trench-"______----- `✓--1 x .. ------ I Number of%lines-- _-.----- Total len th Type _-r fi"lher�, aterial---- -j/�k°----------Depth of filter rnaterlal------_-� - g "` Well -Dept'n------------------------ Seepage Pit: Distance to nearest well._.__=_�`�iR material efrom foundation pi�meter___.Distance to nearest of Ina__--..--_"-_____ ❑ {umber of pits-------- ------ g Lining material---------------------- Cesspool- Distance from nearest well------ from foundation------------- :-,--Liquid Capacity-.-.--------"-- --.--------"gals. ®' 1 ❑ P Size: Diameter------------------------------ -------Dept ---------------------------- Distance from nearest well------------------------------ --"--'-"""-- ----Distance from nearest building.__._.------------------------------- Privy: ----------- --------------- -Privy: �� a ----------------------- ------- ❑ Distance to nearest lot line------------------------------------------------ , Remodeling and/or repairing (describe)- --------------- - --------- ------------------------- --------------- i ; ------------------- ------ _ _ ------------------------------ ------------- i --------------------------- -------- ----- F-- ' his a`licatien and'that the work will be done in accordance with San Joaquin County I hereby certify that I have prepared t pp ` ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor) (Signed) Title By:------------------------------------------------------ - ---------------------- - - wells (plot plan, showing size of lot, location of system in relation to , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------ DATE----------- �"--- -3 -- --------------- APPLICATIONACCEPTED BY------------------------------------------ DATE--------------- -- ------- -----• ------------------- -----------------------I/ ` DATE---------------------------- ---- -------------- ----- -- -- ---- REVIEWEDBY---•--------------------------- ---- --------------- - BUILDINGPERMIT ISSUED----------------------------------------------------------•---•----------- ------------------- -------------------•------- •---------------- -------- ------ --- ------•-----•-------- Alterations and/or recommendations:-----"-------------- ----------- - --------------------- 7� -7'7---------------------------- F}NAL INSPECTION BY----------------- G. Date------------------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street Sycamore Street 300 West Oak Street 132 SyTracy, California 130 South American Street oManteca, California Ldi, California 1 Stockton, California ' FS-4-2M 10-52 Revised W-2100