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APPLICATION FOR SANITATION PERMIT Permit No.4 =..^4............. (Complete in Quplicate) � y iS Date Issued ----------------------- Applicavion is hereby made to'ahe San Joaquin Local Health District for a permit to construct and install the work herein-described. This application is made in compliance with County Ordinance No. 549, F (�70 �� JOB ADDRESS AND LOCA TION-----' ----------- = -...... ----------- JOB Name------ I= "------------•----••----•-- ----------------- = - : Phone Address44 � ------------------•-------------------=----------------------------------------.-..------- ...-----•--------------------------------- 1 Contractor's Name----- ---------------------------- -••------------------------------------------------------------•--- Phone----------------------------------- Installation will serve: Residence -Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑• Other ❑ Number of living units_ ____ Number of bedrooms . _ Number of baths _ Lot size __ _ __J / } ' Water Supply: Public-syste j'� ommunity system "❑' Private EIDepth'to Water Table _2�ft. Character of soil to a depth,5£3 feet: Sand F-1 . Gravel El.. Sandy Loam ❑ Clay Loam ❑ Clay L] Adobe 6-Hardpanf E] Previous Application Made:AND es ❑ No 4- New Construction: Yes El. No �TYPE OF INSTALLATION SPECIFICATIONS: r J (No septic tank�or cesspool permitted if public sewer is available within 240 feet.) Septi.,Tank: �Dist��nce �fropm nearesr wet-+ Distance from foundatio "=___.Mai`L__._____ ____ - m artments._.____ Size_.�'�ce X_S�r�_Q____-:_..Liquid depth---`T�_ ____ __ Capacity____ �n__._. Disposal Field: Distancefrom_nearestwe9.___._. 7_-.-,Distance from foundation-------_------'-----Distance to nearest lot line-_--_---___---- No- o co Number of lines:_____ :_- _-_----Length of,each lino------------------- -------Width of trench----------------------- ----____-- yp alter material-----------------s Depth of filter material-----------_'--- -----Total length--: Type of f - _ _ _ _ ,� �. . �..M . _ a _ fir., .�. .. . . -.._ � Seepage Pit: Distance ,to nearest weld- _Distance om fou dation____. _ ._Distance to nearest lot line ______ N Number Ivf ifs.---- _Lin'in material____ _ Depth___z-` "_ ___.___-______- ' ___ Size: Diameter_ _ ___ _________ Cesspool: Distancelfrom nearest well-------I----------Distance from foundation=_.-______.--.___.Lining material----------------------------------------- ❑ Size., Dia m_Je�------------------------- ---------Depth----------------- -A-------------:-------------- --.--Liquid Capacity------- ----------gals. Priv Di ance�from nearest well _-____-_ ._--1-_ . Distance from nearst building.: .. Privy: _ _ a ❑ ------------------ ----------- ------- * --------------------------------------------------- Remodeling ------ -. -----•-------------------- Distanceto nearestr�lot line -- . a , ... ...., ,.. _.. .,. .._.,�. Remodeling .and/or repairingi (describe):------------------ :----- ---------------------------. --••------- -------- ---------------------------------------------------------------- --------- 1 :... .:----------------------------------------------------------------------------- r --------------------=--------- = _----------------------•-----------------------------------... _,_.,._•] " ------------•--------•--------------`---------------------------------------------------------------- -y I hereby certify that I have prepared this•application and.that the work will be' done in accordance with San Joaquin County ordinances, St laws, nd yule tl`regula+ions of the San Joaquin Local Health District. ".' r x J J �� ' = - ��Contractorl (Signed)---------1 •--- ------- ------------- - - - A , - -- size of lo# location of system in relation to-wells, buildings, 1 ' J� = (Title] - ----------------- (Plot -- - -------- Y• - [Plot plan, showing y Idings, a+c., can be placed on reverse.side]. I� FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED ABY - r --------------------------------------------------------------- DATEt----- :;;--.-:-----=--------------------------------- REVIEWEDBY-----------------------=- �---------•--------------------•---------------- DATE--'.--. ----•-- ---•------.-._.:.--------- BUILDING PI=RMIT ISSUED Ip - --------=------------------------------- ------=--------- DATE------------ ---------` .A� :. - ___________________-_________..__ Alterations and/or recommendations______________' l - ' { ---------------------------- ------ ----------------- ------------------------- ------------------- •------------'-------- •---•------------------------- •- ------------------•- ---------------------------------------------------------------- ----- -------------------------•--- --•------------- ----= ------------------ ---------------------------------------- -•------- --- --------- -- -------- •--- ---•-•--••----- ------ -- - -0--------------------------- ----------------• -•----------=----- ----------------------- ---------- -- -------------------- - FINAL INSPECTION BY:_._4 Date-..: �.:, =' � ` ` f --- 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 i ES--9-2M Revised W-2100 ,r