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APPLICATION FOR SANITATION PERMIT Permit ________ (Complete in Duplicate) Date Issued ------j!?_'__s1 Applica{ion is hereby made to the San Joaquin Local Health j)istrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinan, e 'No, 544- ' �JOB ADDRESS AND LOCATION____-__ -------------------- ••-•-"--- ' Owner's Name---- --------------------- ------------ - - - ----------------------- -------------- Phone------------------------------------ Addressr"'"` ----------------------------------------------- ------------------------------------------------------------------------------------------------------------ Contractor's Name. _` ��. { -�l:z t Phone Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E]. Other ❑ Number of living units: _-/__ Number of bedrooms _J. Number of baths .f ,� ----- Lot size ------- -- -•• --- --------L�---=--------- Water Supply: Public system 2--11community system ❑ Private ❑ Depth to Water Table 31__ ft: y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoaCaE]m ❑ y Adobe❑.•hardpan F]Previous Application Made: Yes ❑ No New Construction: Yes F1 No ❑ / s , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tic Tank; Distance from nearest well-----------------Distance from foundation------------- Material------------------------------------------------- No. _.___._._.---._-._-.-_----___---.______._-__-.No. of compartments-------------------- -----Size--------------------------------Liquid de fih--------------------------Capacity Did o al Field: Distance from nearest well-------------- Distance from foundation----------------....Distance to nearest lot line----------------- / �. Number of lines-----------------------------------Length of each line-------------------- ------.-.Width of french.---------------------------------- t� Type of filter material._-....____ .�___,__�_.../_Depth of filter material---_---�Q__r__Total length-------------------------------r...!_.. Seepage Pit: Distance to nearest well._- 'Distance from foundation...................Distance to nearest lot line___-!_-----_ [� Number of pits----r____._._------Lining material. a_SJIS..--.Size: Diameter______;7__" -----Dept'n+ � `Xk_ -� 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}-- - ----------------------------------------------•------------------------••---------------------------•---------------------------------...,--•------ ----------------------------------- ----------------•--------- ------•------ --------------------------------....---------------------------------------------------------------------------------------------------------- I hereby 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&NIGHT (Signed)----- „ ; -------------•Sep iz_Tanh—Scrviza---------------- ---------------- 1206 -------------- �{9w Contractor) B :_. 11206 So.Eldorado NO 2-70^b (Title)--- ------------- --------- Y ---•------------gtocl�9��s;ira,i ----------------- ------------ ��" Plot plan, showing size of lot, location of system in relation, wells, buildings, c., can be placed on reverse side). ( P 9 r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- �), e """ " ---:----- •----------------------- DATE WW 00-4------ REVIEWEDBY-------------------------------- ------------------------------------------------------- DATE-------------- .. .. BUILDINGPERMIT ISSUED---------------------------C----------------- ----------------------------------------------•---- DATE-------------------------------------- -------- ------------- Alterationsand/or recommendations:------------------ ------ ------------------------------------------------------------------------------------------------------------------------------------ -4 ____________________ - ------ ---- � ��--- = - y FINAL INSPECTION BY:---.-- ------ - -------------------- Date------1 '------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak $tree+ 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 A-00D