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,. APPLICATION FOR SANITATION PERMIT Permit Nv. (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 County Ordinance No. 549. JOB ADDRESS AND LOCATION--------------- •z' .'�1 rr� . PKOwner's Name. !` f-- - ---- ---- -------- ----------------------------- Phone------------•----------------------- Address----------------------- -�---- - `� -- ----- -------- Contractor's Name -- - 11-'--x=- f = �.i------ ------------------------ Phone--�•l�' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J__._ Number of bedrooms ___Number of baths ---k Lot size ---- .--.�-X__/---�-v____-- Water Supply: Public system [s-<Ommunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe 3---H'ardpan ❑ Previous Application Made: Yes ❑ No D--�New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Ta Distance from nearest well-________________Distance from foundation--------------------Material _..-____-__.__.__________________.__-__..____._. No. of compartments--------------------------Size----.---------------------------Liquid depth- ------------------------Capacity..--------------------- Dis al Fi dr-- Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line-----_------------------------Width of trench------.---------------------------- Type of filter material__________________________Depth of filter material----..__.___...._/.-Total length_____._-_-____.________ -______�_r- Seepage t: Distance to nearer well_AF7r '✓______Distant rom f undation___J_Q___-_.--.DistancS to nearest lot line_�s___.____. [ Number of pits----- -------------Linin material_ _ _._---_-_ Size: Diameter_____,.----____ P 9 - P ---------------- pp Cesspool: Distance from nearest well-_._-_______.__Distance from foundation--------------------Lining material-------.______._________.____________. rV ❑ Size: Diameter------ ---- ------ ------ - -- --- ---Depth-----------------------•----------------------------Liquid Capacity---------------------------- gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.----.--______________________.__..______- ❑ Distance to nearest lot line----------------------------- ----------------------------------------------- Remodeling and/or repairing f describe):--------- ----------- --------------- -----------.....----------------------------------------------------------------------------•--------------------- -----------------•-------•----•-----------------------------•---------------•--------------------..--------•-••-•--------------------------------- ------------------ -----•--------•-------------------------------------- -----------------------------•--------------------------------------------------------------------•---•----------------------------------------------------------------------------------------------- ------------ - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------- ► DAY& NIGHT + * Contractor) ---------------SePfWT0-nk-S46TMre ---------- ------ ------ - ---------------------------------- 1206 So. Eldoracf o.__.HO.2:7.a4G------- --- (Title)____-- -- By:--- ---- .. ------. (Plot plan. showing size of lot, 10 MP19f ;3Wm in relation to ells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------R...... -- -- DATE-------__-- � ----- ------------------------------------ REVIEWED BY------------------ ------------ -------- ------ x - DATE--.-- ----- ---/ -----/ ------------------ BUILDING PERMIT ISSUED ----- - ----------------------------------- DATE-------•--------------- - �---- - - --- -.•- Alterations and/or recommendations--------------�._._.------•------_--------------------------------------------..._...-----------------..---•--- ...--- ------------------------ ------------------ ------ ------- --------------- � --- • -- - -------- - 0-------- - ------------------------------- ----- -••---------------------------•-------------------- FINAL INSPECTION BY:--- ---------------------------------- Date------j�_._l ---` � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 nrw000 12-S4