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1ki APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �i/ Date Issued/--/,�_�/ ..--- Application is hereby made fc'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 Ordinanr% No. 549. JOB ADDRESS AND LOCATION----1-3--3 ' -et.�------------------------------------------ -------•----------------•-------------------------------- Owner's Name-------------------------------- - R- p Address-------------------------------------- "' -... 7�...._. ..... �! ----------------------- Phone--�-'-�--��,--------- Contractor's Name-------------------------... ------- ......xpc---------------------------------------------------- Phone--- `= 6 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] otel ❑ Other ❑ Number of living units: .1 ---- Number of bedrooms PJ- Number of baths •-.1--- Lot size _---_- --- --- - --—------------- Water Supply: Public system A Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla oanY Clay Adobe ZL Hardpan ❑ Previous Application Made: Yes ❑ No j4__ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) P Distance from nearest well-----------------Distance from foundation--------------------Material-------------------------.-_--- � No. of compartments--------------------------Size---_----------------------------Liquid depth-------------------------Capacity---------------------- � Distance from nearest well----------------__Distance from foundation--____-----------.Distance to nearest lot line_--.---------- -�. Number or lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- - Type of filter material-------------------------Depth of filter material-----------------------Total length---.-----------.---- --------------------- a .----._------_-_--. W res Distance to Weare t we11401i ,-_'Distant fr my �undation--- _ �_-----Distance to nearest lot line-.-- - Number of pits_--�_----------------Lining material tGl� - .Size: Diameter-_��!!..---.Depth--w��---.------.._.__.. // t Cesspool: ` bistance from nearest well-----------------Distance from foundation.-.-----------------Lining material._-__--------------------------_-----. Cesspool: l�. �Siie: Diameter--------------------------------------De th--- ------ _-Liquid Capacity ---gals. r�Y q p Y g Privy: Distance from nearest well------------------------------------` ----- ---'Distance from"nearest buiHing-----------------------------------------. 0 ' Distance to nearest lot'line--.::-.-..--------------------------------------------------------------- Remodeling and'/or repairing (describe):-------=---------------------------------------------------------------------- ------------------------------------•-------------------------- --------------------------------------------------------------------------------------------------------------•-:�------------------------------------------------------------------------..--------------------------- --------------- ....... ------------..-----•---. -------; --•---------------------------•-----------------------•------•-------------------------------------------------------------------------------------- ----- ---------VSfafe --------- ----------------------------=---------------------------------------------------------------------------------------------------------------------------------------- I he t I have pre are is applicati n and that-the-work-%y'ill"be done in accordance with San Joaquin County ordinancs` nd r es and"regulat ns 'of tli S n Joaquin Local ealth District. Contractor (Signed) ) BY --------------•-------------------------•--- --- - ------- {Title) -------------------------------- (Plot plan, showing size of lot, location of syste in r' elation owe s,-buildings, etc., can be aced on reverse side). FOR DEPART NT USE ONLY APPLICATION ACCEPTED BY-----------------------------_ -'-- � ------ DATE.-.--9--I2 - --------------------------- - -- BY----- -------------------------- ------------------ ----------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------•-------------- ------•-- DATE-------------------- - - ------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------•-••--•-•-•-•-----------------------------__----------------------- ------------------------------------- ----------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ------------------------- ---------- ------------------- --------------------------------------------------------------- - - a .5, FINAL INSPECTION BY------------------ Date----_ l [24/ ------------------------------------------------- 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 10-52 Revised W-2400