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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate(rtrX q / Date Issued ------� Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the workerere described, fihis application is made in.compliance with County Ordinance o, 549. i I = I JOB ADDRESS AND LOC AT _s_/_- --�_ - iY �l A ------------------------------------------------------- 2, . Owners Name 1.1:x. = = --- ------ -- ------------ - - -Phone = .--- ---------------------------------- - Address - � ..:_.. ... �•`-- ------------------ Contractor's ------------ - •' Contractors Name- ' -------------- ---------= ------------------------------------ =-' -.y_ . '� e ------------------o f r Phon -- •--- 7 Installation will serve: Residence [ Apartment House F]- Commercial E] Trailer Court E] IMotel E] Other ❑ I Number of living units!_/_' of bedrooms=-!`-=_`Nu�ber of baths / �7' !*__ Lot size __ � ---------------- Water Supply: Public'system Corrimunity'system E] Private E] Depth to Water Table Q_. ft. " Y Character of soil to a depth � 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ C ❑ Aclobe0 Hardpan ❑ Previous Application Made: Yes ❑ No E] ;' New Construction: Yes•[I-�No-❑--6 // TYPE.OF INSTALLATION AND SPECIFICATIONS: r F ► E k (No septic tank,or cesspool permii-Fed if ublic sewer is available within 200 feet.)' = y f Septic Tank: Distance from nearest well____ _:Distance from foundation__..._---_- --------Matefiat___�'�__.-----_ ---__-_____---.-------- No. _._--. N fi of compart�ants_____ .___ate________ Size__ �_i, _3 6--_.___Liquid depth____ --------------- aci -� ---___ Capacity ty-- Disposal Field: Distance from neares well- Distance from foundati n _� Distance to nearest lot line-- -d-�--- Number.ori Jines _ _=- -Len th-of.each-line_y--6-a----=--�-- -----Width of trench..-- y •� � ' g ----,--------- See a e Pit: Dista of filter material_- �_ _ _`Depth of £Iter materFaL__._ _-___ Total length__ ________________494_.=____..:___ 1- Type ,- = ,.. p g nce to nearestlwell-'___---------_-.___Distan e #rom foundation___-__•_____________Distance to nearest lot line----------------- Nu'mber Sizer Diameter----•--------' - ----.Depth ❑ Number of pits_--___.__..__.______Lining mtatenal________ __ \^ Cesspool: Distance from nee s.t_wefl_________________Distance from foundation------ -- iqund material ____________- _______.__` X11 Size: Diameter t_ _____ y gals. ❑ s = Depth : - Priv Distance from nearest weft_________________ __________ . 1`-s_._Distance from nearest building i y - --- --- I ❑ Distance to'nearest4lot line---------------= - - ._,. .-.. . - g--1 _ -------------- ------ -------------s------- --- ----------------- -------- Remodeling and/or re airin cast, t __ ________________________________3_______ I__._________.__________-_-_________-_____________--___._--_ :tiN*------------------,.. i _ _____________•-____________ -----------------------------I-------------------_---I-------------------- -----------------------------------------I--------- - -- ordinances S- ---- laws and r- - - -- ------------_ r. �..- --------•---•---------------•------------------- -------- I herebyif that! ha ve prepared this application and that the work will be done'in accordance with San Joaquin-County ul an regulations of the San oaquin Local Health District. `' ------------- (Signed) `"� `� l --------- -. - --------- ----- -- - -------------- - -_(Owner and/or Contractor) Plotplan, D ' I ( P BY- --=-�------- =�---- - ------�------ -----(Title)-_--�- -------------------- --------------------------- Ian, showing size of lot,llocation of system in ation to wells, buildings, etc., can be placed on reverse side. a %w' I FOR DEPARTMENT USE ONLY } APPLICATION ACCEPTED __..DATE,------ ------------------------- _ . .. 7 REVIEWED BY- =-------- ------------- O- Y ------------------------------------------ DATE: -v BUILDING PERMIT ISSUED-------------- --- ----------------------_.-- DATE-------•-------_ --- - ----------•--------- Alterations and/or recommendations_____________ _ __- �;� - ----- ----------------------- --------------------------------------- --------------------------------------------------------=---------- ------Z------------------;----•-.-------------•-----------.......--------------..---•----------------.-------- r I ,. .. 1 FINAL INSPECTION�BY:. ': _- . - �//7. -- - --- -- ----- � ------ - ------------- Date----------- ---------- --- � ------ . -------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100