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APPLICATION FOR SANITATION PERMIT f Permit No. -- -- .._ (Complete in Duplicate) I r r Date Issued Applica+ion 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 County Ordinance NO. 549. JOB ADDRESS AND LOCATION------ � Owner's Name------- � Phone -------- ---------------------- ---- ----- - ----- Address----- -------------- (�`.... --. °--. Contractor's Name--------•-• ;�� "f � ---- � ---- CI —�'----------------------------- Phone ---------------------------- -- " -1 Installation will serve: Reside4--- ❑ Apartment Lijause Q"'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _/---- Number of baths ------.- Lot size ----e__,-_-.--._7°� -- -�-------------- Water Supply: Public system %�160mmunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 13-14'ardpan ❑ Previous Application Made: Yes 0 No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) cr_t�. Distance from nearest well-----------------Distance from foundation--_------....----...Material---_.-------.-___-____.._---___----.-._-._-. .._._. No. of compartments- --- ---- ------ ------Size----------------------------•---Liquid depth.--------- ---- ----------Capacity--------------------- 6i osal Field: Distance from nearest well--- Distance from foundation__ ._....Distance to nearest lot line-_-iF ..--_-__- --"'� Number of lines------- _..._____ .a _Length of each line--_-__7.j !�}.......Width of trench.-_-_ ___ .! .__.___.___ Type of Cter material_--�`� C Depth of filter material-__-.1_�ll-_/f....Total length__ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----_------_--._- �ob��] Number of pits----------------------Lining material-----------------------Size: Diameter----------.------------Depth--------------------------------- Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material--.-_----__----.____:_-----_---..__-. ❑ Size: Diameter--------------------------------------Depth.---------------------------------------------------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well----_-----_-------_------------------___________-Distance from nearest building_._____.____._________________--___..__. ❑ Distance to nearest lot line-----------------------------------------------------------------------•--------------------------------------- ; Remodeling and/or repairing (describe):--------- -----------------------------------------------------------------------•-•--------------------------------•-------•----• -----•-------------------------•----------- --•-•------------•----•---------------•-••------- ........................----------------. ----------•---------•--------------------•--------------------------------- L' ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1-here6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. DAY 1RlIGI1f � - Own Contractor) (Signed)--- . y ,- --•-----------Fie}Y?ic-Titeil�t-'Serv�ce BY� 1206 So. Eldorado_.-k10_�704•Pa [Title)--= ---- -------------------- ------------------------------------ [Plot plan, showing sire of lot, local� �°gjs ¢m relation to�wells, buildings,�e c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- DATE------'�-/ -------------.-------- ----------------- REVIEWED BY-------------------------------------- - DATE =-- BUILDING PERMIT ISSUED----------------------- --------- Y DATE--------- r Alterations and/or recommendations:------------------ -----------------• - -- - ----•--- ..... ------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- --1------------- - ------------------- ---------- - ---- -------- ---------------------- -- ------- -------------•-- ---------- ----- - - --- -------- ------------•--------------------------•------------------------------ FINAL INSPECTION BY:....- --- --------------------------------------- Date------F.---------- ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATwonn