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\\ �` -APPLICATION ,FOR .SANITATION PERMIT Permit o. .___.- (Complete in Duplicate) ' +� �� 1 Date issued .__ __/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with.Counfy Ordinan No. 549- :. - _ o r JOB ADDRESS AND LOCATI N=�Z _. .. ---------- �----------------- ------------........ - Owner s Name - ---- �[/1 `_` = - Phone. �,E�_T�+�.7�. Address__ r r� ,�_ -•---(?.r�_----� --- -----------------------------------------•----.. --------• --•--•-- ------------------- - ------ Contractor's Name--•----------- --- -_--� -- ------ Phone_e Q�.... 1. Installation will serve: Residence Apartment House ❑ Commercial p Trailer Courf ❑ �Motel ❑ Ofher ❑ Number of living units: • __ Number ��kof bedrooms _ - Number of baths _ ___ Lot size _____!_ _ f_________________i Water Supply: Public system�[6- `ommunity systerri ❑ Private ❑ Depth to Water Table ft.'- Character of soil to a depth of 3 feet:} Sand ❑ rave ❑ Sandy Loam [:]' Clay Loam ❑ Clay ❑ Adobe �ardpan El Previous Application Made: Yes ❑ No [4]�NNew Construction: Yes ❑ No �HA/VA: Yes ❑ No [ '� E TYPE OF INSTALLATION AND SPECIFICATIONS: [ (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ept%o a 1pk: Distance from nearest�wel1l__�_�_____ Distance-from foundation____________-__-__:Materia#_________________________________________________ 14No. of compartments--' ---------------------Size------------------------------Liquid depth---------------- -----,Capacity---------------------- __ . ispo -i Id: Distance from nearest well--------_________Distance from foundation___________!......Distance to nearest lot line____________.... Number of. lines_____-_____� ._________-___._ Length of each line_______________________t_____-Width of trench-_-___--_--__-_,_---_. p g f filter mat#i I __ e th of filter material-------�--- -----Total length------------------------------------------ Seepage -------------------------•------•------•- TYpeO i �• .:, , -------------- -- See a e f Distance— ` e. - e to nearest well:_______ _' Distance m. fo hdation___ � Distance to nearest lot-lin/_-�d ._ 4 Number of pits___-- -`_------_;__ Lining material--- --_--_-- p ,, �-------------------- --- 1 > _-5ize: Diameter___i�' ___ .____De tn___ ___-- Cesspool: Distance from nearest well-----------------:_Distance from foundation--------------------Lining material------------------------------------- El ___ _-_-__________________________-_❑ Size: Diameter---------------------------------------'=Depth------ -------=------------------------ -------Liquid Capacity------------------------------gals.; 0 Privy! Distance from nearest well_______________:______,_ _______________,____Distance from nearest building-------':__-__-___________..__--_._____-- ❑ 'Distance to nearest lot`line--------------°:--------' -� `-- ---------- - --------------•--••--------•-------------••------ E -;-------------- ------- --- ----- , f Remodeling and/or repairing (describe)�-------------------------=------- ----- ----- -- -•------------•---------- ------------ ----------------------------- - -------------------------------------------------------------------=---------------------- i I hereby certify that I have prepared this application and,that the work will be done in accordance with San Joaquin County ordinances,,-s a a laws; and,,rules a d regulations of-the San Joaquin Local Health Distric+. ------------ (Signed) �, f k ------ ---- I}�- _. r------ - �� -------------------------------------------------------- - - caner and/or Contractor) Tif {plot - tan, showing size of,iot,�a oefatn�to`wells,--buildin s, etc., can(bele}-laced on- ----•------------------------------------- p gsystem � g p reverse side}.. . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- --------- DATE-•-- -----:::::::REVIEWED BY - -----------------------BY =---------------------- '------ =--------------------.---------------------------------- DATE---- = ---- •----------- 1 BUILDING PERMIT ISSUED--------------- '- -- -------- -- DATE------------ _----- -------------_--------- Alterations and/or recommendafions:------ --� -------------•--------=--------•-------------------------•-- _------------------- ----- fl-y ` . _ . _ -- ---- ` -•- �--J � __-______ ._ _ �-__•I___________________w__________________ _--_-.----_-____---- -Id _ ..._4_!_.. ------_------------------------------------------- ------------------ - -------- - ______________________________-_____-____________-_________-_______________---__�------------------------__._________-__-__________-__-_ _______.__________-___________--_____________- _---________-I_________-_-______-___ - _____________________________----______-_---____----_-____-_-_-._____-_-----__-___--___-________-___-__-___-__-______---__-________-__-_______-__________--...----_-__._-_-_-________,_______-____-________.__-__--- FINAL INSPECTIONBY: = H - Date. _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 West Oak Street 132 Sycamore Street 814 North "C" Streef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revises 1-57 F.P,CO-