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i APPLICATION FOR SANITATION PERMIT Permit No. 11 (Complete in Duplicate) 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 County Ordinance No. 549, JOB ADDRESS AeN LOCATION__----- /, ----- Cv -----U �-----(? ----•--•- ----•-------------------------•------------- Owner's Name --------- ------. hone--- ----- -- d 4 Address...... 5 r Contractors Name---- ---- ------ Phone------- ----------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.-.---.Number of bedrooms -------- Number of baths -------- Lot size ------4e - � 0 ------------------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table __yd ft. Character of soil to a depth of 3 f et: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ No� New Construction: Yes No 0, . TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s 1 { pti nk: Distance from nearest well-----------------Distance from foundation--------------------Material __ No. of compartments------------ -------------Size----•-•------------ --------_.Liquid depth--------------- ----------Capacity----------- Dis al- ld: Distance from nearest well_____.....___.._Distance from foundation--------------------Distance to nearest lot line-_---__.---.----- 44 Number of lines----------------------------------Length of each line------------------------------Width of trench-------------- ----- �. r � p g T e or fitter material.__.l.�_,._________ Depth filter material----________________Total length._____.-._.______.._...___--------------- Distance to nearest welAUWAA--Distance from foundation_,-/A ........Distance to nearest lot line....3a. ....� 1 p Seepage Pit: Number of its.__ Jc" P I------r------ ----Lining material_ ...Size: Diameter------36��- ---- Depth--- "� .......... - ----- " Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--. � ��❑.p �,. ��. . _� material--.--_.------___-__--___Size: Diameter-1-._- .--------- Depth----------------------------------------------- - Liquid Capacity------ -- --gals. Privy: Distance from nte_arest we —_ ------------------------------- ------Distance from nearest buildin ❑ Distance to nearest lot line: , - - - .� ,`... . g Remodeling and/or repairing (describe)---------- -------------------- ------------------------•------------ ---------------------------------------------- ----------------------------------- ----------------------•----------•-•-----------------------•--•---------------•----------------------•--------------- I L_ . --------- --------------------------------------------------- ---------------------------- ---------------------------------•------------------------.------------------------------------------------------------.--------- I here6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ,l ordinances, S7ae laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ----------------------------- ------- -------------- --- -----------=--------- er art rContractor) r . � -- w By:-------- ..._C.{.� t --- --------- -------------------------------••--------------- Title - wn (Plot plan, showing size of lot, location of tem in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYV ----------------------------------------- ----------------------------------------- -------------------------------------- DATE REVIEWED ------------- UILDINGE I --- E -- ----------------------------------------------------------------------- DATE-- -- ATE- -�' BUILDING PERMIT ISSUED -- ----------------------------------------------------------------------- •------------ DATE-.---- fi Alterations and/or recommendations:--------- -- '_ -- ----- ---------- --------------•-------------------------------------------------------- ----------------------- - ------------ -- _ --------------------------------------------- --------------Y _ ____.-___--___._.__ __ ----------..----------- 1r.......... .... . - - -------- -------- I FINAL INSPECTION BY:------ ti -K i( -------•- --- 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 I0-52 Revised W-2100 4