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APPLICATION FOR SANITATION PERMIT Permit No. _______ � (Complete in Duplicate) Date Issue ✓ ' 1 Application is hereby made 11to the San Joaquin Local Health District for a permit to construct and install the work herein described. F jThiVapplicafion is made in compliance with County Ordinance No. 549., JOB ADDRESS AND LOC TION--------------- - ------- wner's Name------------------ j 0 �7 • .l_ f l- f! Phone------------------------------------ 0 II II rd f Address----------------------------------------------- C.,��41 --- �•�--- ------- �`--------------• Contractor's N�Reidrdce ------ y •, /750ne----•-------•-----•---------------- Installafion'will Apartment House ❑ Commercial ❑ Trailer Cou [I Motel ❑ Other ❑ r � Number of living units: __/-___ Number of bedrooms _A Number of baths _y Lot size .7 -.' -� _ ________ Water Supply: Public system [I Community system ❑ Private ® Depth to Water Table -------- ft. Cgaracfer of soil to a depth':,of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [EClay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made:.IlYes ❑ No X -New Construction: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cetspool permitted if public sewer is available within 200 feet.) -- _ Mateal_ G_' v,f oun anon---j�_------ _ � _ _- Se ® Tank: DistanceiE ropm nearest well ��__Distanc fro f �,„ p - 7� 1 No. of com artments_..__._.�__________Size_A--_� - � I -----f'�------•---Liquid dep�h--•�"- ------------------Capac�tY-� —/ Disposal Field: Distance from nearest,well___,.)_D-..,Distance from foundation----rr2V-__.�_Distance to nearest lot life__ _.____.__- R1 Number .of DoT lines__:'�_,�=>-y--=.- �. � Length of each line�_4_� D P3�._.Width of #Tench---=��,•------------------ T e of'.filter material__S e..__'C__De Depth of filter material___.1 ___ p Total' length-------/3- 5�__----- See a e Pit: DistanJ'fo nearest well______________________Distance from foundation__________________ .Distance to nearest lot line__.____._________ , P g _ . . ❑ Number�of pits----------------------Lining material-----------------------Size: Diameter----------_------.-------=DepM--------------:-r-----_------------ Cesspool, Distance iz to D a from nea-rest well________-_-__.__Distance from foundation--------------------Lining material_____________________________________ Priv Distance from nearest well---------------------�--�-- _----- -- -----••--- --- - - -- -- • =-=--Liquid Capacity---------------------------- meter-- -- ---------`-- -- Privy: --_ t .................Distance from nearest building__r______.__,_----------_-__-._-_._----_. I ❑ Distance`to nearest lot line--------------------------------------------------------------------------------------------------------------- ------ - - � Remodeling and/or repairing (describe)________ ___________ C 11 V - -------------------------------- ------ - --------------- ----- ---- - ---------------------------------------------------------------------------------- ------------------------•----------------------------------- ---- -------------------------------- ---------------------------II iI � .. .. ----------------------------------------------------------------------------------•-•- --•-----------------------------------------------------•---- ---- II IMi I� I hereby certify that I li�ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State. ws, and 'rules nd regulations of the San Joaquin Local Health District. i __ _ _XA I`R ' (signed)•---- _ _ Vt �------- - ---- - - - - and/or Contractors I By: .._.. .:.... - -..--{ ---------------------------- (Title) -------------- (PIl�t plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side]. PAR ENT US ONLY . APPLICATION ACCEPTED BY--- DATE------ � ✓ J ---------- REVIEWEDBY---------------------- ----------------- ---------- ----------------------------------------------- DATE--------------------------- 1-------------.---------- BUILDING PERMIT ISSUED.1`•---••-•-----------------------------•---=---------------------------------------------------------- DATE---------------------------------------- Alterations and/or recom - .- me dafions:------- ------ --- -------------------------- ------.-.-.. --------- ------------. ---- --.--------•- -------------......------------------------------------------ I . II II --•------------------•----------I -----•-•-- ---- - ------------------------ -------------------------•----------------•-------------•--- ------------------------------------ 11 I ------------- -------=------------------------1---------------E--- ------ - ---------- ----------- J IINAL INSPECTION BY::If�l__ -------------- -- -1-- ------- ----------- - - - Date- - ------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street ` 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I. Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2104