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APPLICATION FOR SANITATION PERMIT Permit No. i_.__7_� - (Complete in Duplicate) Date Issued Application 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-` ± ` .f r � �, •�, y( t__-__--_-- ------- ? a Owner's Name-----------•---------------------- - - - - - ------ ------- -�f--s----------------------- Phone---------•--------------•-----•-•-- Address....................................... - ----•l"" °. Contractor's Name---------- ------- — ----- ......-=---- ---------•---- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer-Qourt ❑ Motel U Other D Number of living units: -------- Number of bedrooms -------- Number of baths J--- Lot size -----------------------------------------„ C✓u-v__ Water Supply: Public system 54. Community system ❑ Private ❑ wDepth to Water Table _ "r ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam W Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No)< New Construction: Yes kms' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-t6-AIL Distance from foundation--t- ------Material-.-- ------: �._._-.__- C -._tY i quid ode th No. of`com artments--.1 -.-_--.-----Size- O' aci 1 d p Disposal Field: Distance from nearest well444- E-Distance from foundation_—S-- ----.-.Distance to nearest lot line---- Number of lines----�___- _�_ Length of each line__ew9+_0-------------------Width offrench--_� ' ----------------------- -- _' __ ---._ ._----.---- Type or filter material _ ----------- of filter material---1- '`'......_Total length.--.__a'_"0Q-'____------------- _,._ Seepage Pit: Distance to nearest welI71 ,,, Distance fro' foundation---I-S-_"-_-_.Distance to nearest lot line_---------------- 4~ Number of pits------I------ -------Lining material_I ----Size: Diameter__.,0Y'7 "-------Depth-----l2-.r----------------- Cesspool: Distance from nearest well------------..__Distance from foundation---_--------------- Lining material------------------------.___-..__..__. 4 ❑ Size: Diameter--------------------------- ----------Depth-------- ----------------------,-------- -----------Liquid Capacity : - --------------------------gals.. I` Privy: Distance from nearest well----------------------------------------:--:----Distance from nearest building. __._.___-------_---------------.`---- ❑ Distance to nearest lot line----------------------------------------------- ----------------•--------------------------------------------------------------------- ----:r r . ' a Remodeling and/or rep rind (describe �- a - -��--'-.U-Cx�n.�--- ---------- ----------------;- •-----------•----------------------- ------------------------------- -•-• s -------------------------------••/1--- -- -- ----'------- /------ —-------------------------------------------- ----- ---------------------------------- Lrules --------------------------- ------------------------- ----------•----------------------------------•--------"----------•------------------------------ ----------•--------•-=--•----------------------------------- 1 hereby cert�Iawpsand ared this application and that the work will be done in accordance with San Joaquin County""`, ordinances, State regu! on of the San Joaquin Local Health District. ----- ---- -- ------ ---- ------------ ------ -------{ -------- (Signed) Contractor00 $ fi (Plot plan, showing size of lot, location system:m la i + Is i mgr, etc., can be aced on reverse side). F EPARTME USE ONLY € APPLICATION ACCEPTED BY_ __________________ _ DATE --------- ---- ---- ---- ,f REVIEWEDBY.- --- ----- --------------------------- -- --- -------------- :-------• DATE t---- ------------- ---------- ----------- = g PERMIT ISSUED------------- - --------•- ------------- DATE-------4-------------------- BUILDING ,F Alterations and or recommendations: = = k! + 4 , } ----------------------------------------------- ---------------------------- <-- - � I FINAL INSPECTION BY:.- ------------------ -------_.- } _ Date-_L__-,�_^�-�- 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 ES--9-2M 10-52 Revised W-2100