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o� APPLICATION FOR SANITATION PERMIT Permit No. �. ` (Complete in Duplicate ) Date Issued Applicafiion is hereby made to the San Joa uin Local Health District q for a p rmit to construct and install the work herein described. This application is made in compliance with County Ordinan 54 . JOB ADDRESS AND LOCATION.-,-------- --------5---- ----------- ------------------------------------ Owner's Name----------------- h?_--?--4vc- � ./ -,--- Phone__d Address------. ------------------------------- ----- ------ - Contractor's Name-------------------------- = •' a �. -- V-- = L ------- Phone----- q 1� Q Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I--- Number of bedrooms ---"Number'of baths I___ Lot size ._- _p' Water Supply: Public system CW Community system fl Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, ' Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well-----------------Distance from foundation--------------------Material _-________-_______--______--______--_.__--__-__. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----- S �.�Fiela�: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line__--________-___ `•- 7 Number of lines-----------------------------------Length of each line------------------------------Width of trench Type of filter material-------------------------Depth of filter material-----------------`--Total length---------------------------------- ------ , Seepe Pi+: Distance topearest yrell__ __-_Distance fr�ndation__�_,_t______________ Q t r Na Di ace to nearest lot line-.,�0 -: f" Number of i+s______ ______________Linin material___--_____-_____-(----Size: Diameter_____- ___�`_� Depth_-_ � Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------ .______-.___. j y ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. 1 Privy: Distance from nearest well------_------------------------------------------Distance from nearest building----------------------------------------- n Distance to nearest lot line Remodeling and/or repairing fdescribe)_____________________________ ---------•------------------------------------------------------------------------------------------------------------------------------------ ---------•-•----------------------•----------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I*ave prepared this�applicatiori''and that +he work will be done in accordance with San Joaquin County ordinances, f fe laws, and ules and regulatdons of +he'San Joaquin Local Health District. (Signed]- ---••`-�� - ( ..1 ------------------------------------------------------- --- tract B�' - ----------------------'-------- _ -------------------------------------------------------(Title] F .�.. Contractor) ------------------------------ (Plot pla , s owing size of W, location of stem in relation to wells, buildings, etc., can be pln reverse side). ] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 6Y___ ----- ______________________ DATE_r - - ----------------------- ---------- ------------------------------------------------- -- ------------------------------------------------ REVIE ✓ED BY -- ---------------- ---T - ------------------ -- --------------------------------------------- DATE ,BUIL - r----------------------------------------------- D1N PERMIT ISSUED ----------- DATE-------- tera+ions and/or recommenoations__________________ ------ ----------- ------------------ - ------------------------------------------------ --------------------------- FINAL INSPECTION BY:-------f -'---------- -------------------- Date---- ` 1 5 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 8-51 Revised W-2100