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APPLICATION FOR SANITATION PERMIT Permit No. ... ... ............ (Complete in DuplicAfe) Date Issued �13_ A gplica4ion is herel6y made to the San Joaquin Local Health District fo a permit to construct he work herein described. District This application,it made in compliance with County Ordina J.Q, 4 Wf he . . . ..........A JOB ADDRESS/k ND LOCATI ------ -- - --- -------- - -- -- -- ------------------------------------- ------- t, f ------- -------- Phone- Owner's NameP- -------------- Address--------------------------- ... '----------------_-- i�E�------------------------- ----------P_-h--o-'n-e- /--v-------li-574-d-7----- Contractor's Name---------------------- ---------------- v will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [3 Motel I-] Other E] Number of living units: Number of bedrooms --$"Number of baths ---/_ Lot size _________________ Water Supply: Public system [+l'�Communify system El Private F-1 Depth to Wafer Table"10- ft. Character of soil to a depth of 3 feet: Sand .Gravel El Sandy Loam El Clay Loam E] Clay 0 Adobe [ardpan E] Previous Application Made: Yes E] No New Construction: Yes E] No De9444,-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if-pub;lic se' available within 200 feet.) jer is a `! Distance from foundation_-J-h--—----Material---- Sepfic '�Pnk: Distance from nearest well- C ---- ------- ---------- ------- No. of compartments-r--Z Liquid dep�h_..._IXT'o!''__..._.Capacity__;Capacity---;�402_0__ _---------------Size,,:M. 0 Disposal field: Distance from near sf well Ad)%A,._Distance4ro-3mfoundation--,/ _.Distance to nearest lot line. Number of lines-.7-------- Length of each line---04 0--- Width of trench.-AfX- ------------------- 0---------- se Type of filter of filter material---------40 4...Total length-------�40------------------- Seepage it: Distance to nearest welIJ4#%a--------Distanc oundafion__2_5,-- Distance to nearest lot I=------ lumber of pits_____.,.._---_-_-__ rom f ---- 4M,---/9._ ----------1_1.nirig material- Size: Diameter.,J-3"t-----Depth...... Cesspool: Distance from nearest well-----------------Distanc from _fo__u___n_d_ af;on foundation....__.________..Lining material_..__-__-_____._____._______________-. ❑ aterial-------------------------------------- El Size. Diameter--- -------------- --- ---------------Depth------------------------------ ---------------------Liquid Capacity----------------------------gals. Privy- Distance from nearest well ----------------------- ---------- ...Distance from nearest building------------------------------------------- Distanceto nearest lot 2lire---- ----------------- -------- ------------------------------------------------------------------------------__------------------------ Remodelingand/or repairing (describe):- - ------------------------------- -------------------------------------------------------------------- ----------------------------------------------- ------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------D ------------- -----------1-1----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ---------- ------------------j-------------------------------------------------------------------------------------------- ------------- ------- - ---------certify A af ave prepared this a the work will be done in accordance wifh San Joaquin County ma "on and Sa ordinances, fate laws, and ules and egulation f the San Joa uiri Local Health District. n a 11�1, I;y fQ ....... --- ----- ----- ------------ ------- Contractor) ed)---------- ------ -------- --- -- (Signed)----- ----- -- -------------------------- --- -- ------- - - ----- --- By:----------------------__----------------------------------------- -------- ---- -- - --- -------- ----------- (Plot plan, showing size of lot, location of system n r allion to wells, buildings, C., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------- ------- ---- ---------- - DATE-,u— REVIEWED BY------------- ---- --I----------------------------I------- DATE.- BUILDING PERMIT ISSUED-------------- -------------------------- ---------------------------------------------------------- DATE-----2- -A--------------------------------------------- ------------------------------------------I--------------------1--_---------------------------- - - Alterationsand/or recommendations:------------------------------------------ ----------------------------------------------------------------V_\--•---•--••--•--------•--••-----...----------- ------------------------------------------------------------------------------------------- -------___---------------------------------I——--------------------------------------- ----------_..........----------- --------------------------------------------------------- -- -------------------------------- ------------------------------------ -------------------------------------------_.------------------------------------- ------------------------------------------------------------------ - - ------------------------------- ---------------------------------- -------------------------------------------------- ---I--------------------- ------------------------------- - ------------------------- ......._---------------------------- I-------------------------------------- -------------- --------:----------------------------------------- Date......../ 155 FINAL INSPECTION BY:............... - ------------------------------------------ --------------------------------------------------------- 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-u-2M 145446A7WODD 12-S4