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N APPLICATION FOR SANITATION PERMIT Permit No. _/r l................ (Complete in Duplicate) Date Issued A lication is hereb made to the San Joa uin Local Health District fo4elrmi't to con tru apP Y q > (construct nclinsta]l4-h'e qo-tk�remmdescrib-e-d ft,,, This application is made in comp#lance with County Ordinan N JOB ADDRESS AND LOCATION Cs{•'�s- ' -� } , .-.---1-- --N -n----Owner's Name Yr Phone �''2 Address---------- ------- - ------- - ------------- . -------- . -- Phone------------Contractors Name------___- Installation will serve: Residence/' Apartment House ❑ Commercial ❑ Traile'r,Court ❑_Motel ❑ Other ❑ Number of living units-. --(----;Number of bedrooms Number of baths------ Lot,size -r cry/ ------------------------------------------ Water Supply: Public system Commuriifiy system ❑ Private ❑ Depth to Water Table'_- , --_ ft, r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gQ_-i?ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes �No ❑ PHA/VA: Yes ❑ No R— ' TYPE OF INSTALLATION AND l SPECIFICATIONS- (No (No sePtic tanksp lP wl_ Pb `a is �`200 feet.) Sept•c Distance from nearest elXADista efom, ounda 'on---/Q---------� Mat r'�l--�---- - -i' -t�-y---No. of compartments-- ------ --------------Size- -----Liquid depth------- ---------------Capac ---d 7-------------------- DisposaDistance from nearest we110 Distance from foundatign-_-lQ--_--------Distance to nearest lot lin�e�_, --- Number of lines -..__ Length of each line _ 1 ----Width of french----2--� _-_--_-__------ Type of filter material-_-'--- Depth of filter material--f; --------Total length--- --------------------- Seepage Pit: Distance to nearest well------ ------------Distance from foundation....................Distance to nearest lot line------..--------- ❑ Number of pits------------------ --Lining material- .____-_.----Size: Diameter----------1------------Depth-------------------------------_- Cesspool: Distance from nearest well-----------------Distance from foundation----_--------------.Lining material--------------------------.____.El r--_.: v Size: Diameter------------------- ----- ------De th-------------------- j-----------------------------Li Uid Capacitygals. Privy: Distance from nearest well--------------------------------------------_._Distance from neare&building-------------------._--_---__-----.----.-. ❑ Distance to nearest lot line---------------`.----------- -------------------- ------------------------------------- Remodeling and/or repairing (describe):--------------------------------------•----------------------------- ----------•--•-------- = --- _________________________ ______________________________________ ________________________________________________________ '--:_-.----.-_-_---____.-____---_--------_-.___.___-_--_-----._--- _--__-__--____ I --------------------------------------- ---------------------------------------------------------------- -___---_--------__-------__------__,.___-___----_-________---.-__-----_---.---___`__.---__-_-- I he eby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordirhan s, State laws, and rules and regulations of the San Joaquin Local Health District. l , (Signe ' ---------------------------------------------------------`-------------------(Owner and/or Contractor) •r SY:------ ----------------------------;---:..-�----------._-------(Title)--------------------------------------------------------------- (Plot plan, sh ing size of lot, ocation system in relation to wells, buildings, etc.; can be placed on reverse side). FOR DEPARTMENT USE ONLY # APPLICATION ACCEPTED BY----------------- - - - -------------------------- ------------------------------ DATE--------------- -••------ ---------- REVIEWEDBY ----------------------------------------- - ----- -------------------- I------------ DATE------------- - BUILDING PERMIT ISSUED---------------------------- ---------------------------------4--- __-DATE' Alterations and/or recommendations:-------------- --------------•---------•-------•------------------•-----•-7---------•-•---------------------------------------- 1,41 FINAL INSPEC --------------------___-- -- --- - PJOAQUIN Date-------- SA 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 Il �'=9-2M , Revises 1.57 F_P.CO. `1,