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APPLICATION FOR SANITATION PERMIT Permit No. __��.�`�___-... s (Complete in Duplicate) Date Issued Applica+ion 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 Count Ordinance No. 549. JOB ADDRESS AND LOC ON } - ----------�---_-- ff Owner's Name----------- - -- Phone--- -- --- -----•---------- - -- - ---- _----=------- Address--------- ---- ev.111 Com•.----- ------ - ----------- ---------••--•-•--- Contractor's Name---------------- - - --- -- - -----------------------------------------------------------------•----------------- phone----------- Installation will serve: Residence P"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f---. Number of bedrooms -,2--- Number of baths _1--- Lot size Water Supply: Public system ❑ Community systerh ❑ Privateepth to Water Table ,eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ardpan ❑ Previous Application Made:' Yes ❑ No @�-' New Construction: Yes ❑ No g-4— " t TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi F ank: Distance from nearest well-----------------Distance from foundation_---.-__.__-_-.-._-.Material_____-.--_____-.-_..___---_____----____.-____.-. No. of f compartments-----------------------.-Size--------------------------------Liquid depth-------------------------Capacity----- ----------f-- ---- DsposallF/eld: Distance from nearest well . --.--Distance ' from foundation_ Distance to nearest I Ii�� --- -, Number of lines-}--_--- --- -- ---- ength of each line-----10_P--------------Width of trench------ --"- -- --------•----- rs �S Type or filter material--- ------_ _`----- epth of filter material-._.-/r------__._Total length-------s0-�------ -- ------------ Seepage Pit: + Distance to nearest well-.1116®.--------Distance from found`ation-- . --------Distance to nearest lot line--_'.. --_ [q� Number of pits----- _____________Lining material-C-�-_ 4�Size: Diameter_-- Pi f • --..Depth ----�n'-------------------- Cesspool- ---- ----------- � 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 logyline-----.--- -- -------------------------------- ------------------ - - ---------------------- Remodeling and/or rewiring.(describe):-_ -'---------- ``�Z r- -� ----------------------------------------------------------•------------------------------------- =----- -------------•--------------------•--------------•--------------------- `� ----------------------------------------------------- I hereby certify that Vhave-prepared fhis-application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r regulations of the San Joaquin Local Health,District. ----- (Signed}_ , Contractor) ---------------------- By:------------------------------------------------------------- ------ ( / -------•------------(Title)---- - � (Plot plan, showing size of lot, location of s min relation to wells, buildings, etc., can be placed on reverse de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B'K?-------- = DATEs REVIEWED BY - . DATE--- BUILDING PERMIT ISSUED - ---------------------------------------------------- = F c ----- --• - ,- DATE.----Alterations and/or recommendations:---------------:-- ---------- ---- ----------------- ----- -- --- ----- . =` -- --------- ----------------------�- --3-- ---------•------------•-------....--------------- # -- -- ---------•-------- -------- ---------- ---------- ------ --- --------------------- FINAL INSPECTION BY......... ------------------------------- Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT { 130 South American'Street k 300 West Oak Street 132 Sycamore.Street 814 North "C" Streat i Stockton, California Lodi, California Manteca, California Tracy, California + ES--9-2M t45446 wrwono 13-54