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APPLICATION FOR SANITATION PERMIT Permit No. n� Com lete in Duplicate) io 1 pat-e Issued Application is hereby made to the San Joaquin Local Health District fora permit to consfruct and install the work herein des ri ed. This application is made in compliance with County Ordinance No. 549. (.: *:, . LU-�^ - 4, � ,• - - JOB ADDRESS AND.LOCATION-------------- .......�'�. =_ �_ Owner's N- ame----- --- -R- , -- -- one ------------ Address- r � ---------------------------�........... j �` Contractors Name----=--------?1-10 - -�� ----�--��---- ---- -•----=--•- - -' .---- -------- -------------------------------------------- Installation will serve: Residence Phone.. - --=�---------=---•--�-� I F p a F-] E] L] Motel L] Other Number of living units: _ Number of bedrooms _ •CNmber Iof bafhs railer of size _ M _________________________ Wafer Supply: Public system �orhmunity system-E-] Private'❑ Depth to'Water Table"_y.` ft: P Characfe� of soil to a depth of 3 feet:i Sand L] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Uk'�lardpan ❑ Previous Application Made: Yes ❑ No N'�New Construcfion; Yes No Er--_FHA/VA: Yes ❑ No E5,---r . a , TYPE- OF, INSTALLATION AND SPECIFICATIONS: w i (No septic tankfor'cesspool permitted if public sewer isiavailable within 200 feet.) S�anDistance from nearest well__lQ11------Distance from foundation__-fL1__.........Material---- l_a�__----_...__-__ D staonce from rriearest wef AO--------Dlistan��r�_-� datio nur��f�f�_'.Distance to nearest Capacity----A'��.-.-----. k om If I Disposal Field: Number of lines________I_____________________ Length of each line_____ ____________,.Width of trench s ��'____ J ; •-------- ------- Type of filter mat enaI__tAr. -r____Depfh of filter material___- j'= - --_Total length_______ i , - _____________ ________________ Seep g NIrar nearest well__1 p � D -- .mfoundnis tan e�onearest lot line- _--_7.� S�6beof pit � __ Lining Yatria�ti - Size: Dim�er - 'Depth_..Q�_�- ----------------- Cesspool:f a nearest well_________________Distance from foundation--_----- ------ r Lining material.------------------------------------ EJ --- --------- i ❑ Size: --------------`---_----'- 1-De th______:----:-------=-------------------=------=--_,Li uicl Capacity • --------------------- als.11 Priv Distance from nearest well----__---------------------- _____________Distance from nearest building -'______..___.'f I ❑ r .-,.Distance to nearest lot line:_ '. .1 ----------------------------------------------------- ----} r . Remodeling and/ r.repairing (describe): = J: c! ------ =, . .� if = --� ---------- -------------- -- ---------- ^h i --------------------------- ------------------------------------- - ------------------- ------- ---------------------------=----------------------------------------------------=•--------------------------------------- herebcertify that.I have re are--�-------------• -•--•-----•--------:----------L---------.-------- •-•------:--, P y y p p d this application and that the work will be done ,n accordance.with-San Joaquin County jam. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. t } (Signed) ° - �2--_______! _ _ sem;. ---------------_--------(Owner and/or Contractor( ------ ----- -------------------------------------- /� t --------------------------- ------- Title _-- �Y� = l/ +� ( ) -� k (Plot plan, showing siz* f lot, I aoE fiiorl of ays+em in relation +o wf6s, buildings. etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY... _._ REViEWEp BY °::: ; ------------------------------------------------------------------- DATE- • -- BUILDING PERMIT ISSUED_' T ---- - �' _ - = DATE---- --------- and/or-refommendations: �� - { ---------------------------------------------_---------•-•------- :... ----------- - ------------------•---------- t ' _ -------- - - --------------------------- --------------------_ --- i i h FINAL INSPECTION BY:_T=- w" Date------------------ , • 3 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 .21A Revises 1.57 F.P.Co- I . r �