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�t1�1 Permit No. APPLICATION FOR SANITATION PERMIT �----- {Complete in Duplicate) Date issued Applica+ion is hereby made to the San Joaquin Local Health District r a permit to co �4ruct and install the work herein described. This application is ma compliance with County Ordina No. i JOB ADDRESS AN CATION--_._ --- -C�--- ------ - - -_-�.i�_ -- + ----- ----- Phon ---------- Owner's Name---------- - ---------------- -------- .-- .... = ----- ----- ----- ! ' am -Address__ ......... • g - Contractor's Name---'---------------- & ----------------------------------------------- Phone._ _.'<�_..b-' - Instaliation will serve: ,Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �,r%3C Number of living units: ____Z_ Number of bedrooms ._y Number of baths Lot size _____________ ---•---------- Water Supply: Public,.system",❑-"Community systern EI—Private "Depth to'Water Table _'ft. Character of soil to a depth of 3 feet: ' Sand F. Gravel ❑ 'Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe , Hardpan ❑ Previous Application Made: Yes,[] No D4, New Construction: Yes ❑ No ❑ TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available`within 200 feet.) Se c Ta k;. � Dis€tance from 'nearest wel-__ .........Distance from foundation---------------------Material---------:____________________________________ ___ Noof com arfinenFs--------I------ S --_Liquid depth--------------_---------Capacity----------------------- spasal Field: Distance from nearest wellt*�=___ Distance from faundafion___� _r--Distance to nearest lot line__ ___ _.. :s Number of lines----- -----*------------------=--Length of each line------.•----la=_�_..'_-...Width of trench.-- _%�------------------------ \ Type of filter materiai__1�_.*_A-__--___Depth of filter material-____ '_____Total length-.__6.��__________________________ See age Pit: Distance to nearest'wef -Q____.__.Distance from foundation ________________.Dista�nce to nearest lot line___1:1 Lining maferial:C� __-Size: Diameter_____ _ Number of pits-----1`--.-------- �- -- ----------Dept Cesspool: Distance from nearest well,_______________Distance'trom�foundation-----..___;----------Lining material____.-_____--.- .____.__________._ ❑ Size: Diameter----- --------=-""- ----- '.-------Dept h_------------------------------------------`-.--------Liquid Capacity----------------------------gals. PrivDistance from nearest well_-.__:._-_'______".___________________________Distance from nearest building________-___.__________-._-___________- y:� ❑ Disfance to nearest lot line__.-"":�=""�.,. 1^.—.n... ... ------------------------------------------------ -------- --,� --------------------------- Remodeling and/or repairing (describe):_.-_.--- — ------------------ ---------------------------------------------------- •------- v t t ; ----------•--- --- .. ----- ---- ------------- _____________.._______....____._._._______._.._______._______________.____________________________________________________ ------------------------------__--------------------------------------------------------------------- I herebyPws y that I•have prepared this application and that +he work will,be done in accordance with San Joaquin County ordinances, St ; and"rules and regulations of the San Joaquin Local Health District. Contractor) --•--. •... - - - ------------ -------------------------•----- (Signed)---------- ---------- k { 3 _.. S _ BY=------------------------------------------------------------------ f111 F {Title) �7_5�_ [Plot plan, showing size of lot, location osystem in. )anon,to wells, b ildings, etc., can be' placed on reverse side). 1. FOR DEPARTMENT USE ONLY } -------- DATE_ _. s APPLICATION ACCEPTED.BY-----------=-- ------ --- •----------- ---- REVIEWEDBY-------:---------------- ---------------' ----i---------------------------4-----•---------• •-----. DATE-------------------- -------•---------------------------- BUILDING PERMIT,ISSUED------_-------- --------- - ----- =---------------------- ------ - DATE = Alterations and/or.recommendations---------------------- -----------------•--------------------------..--------......--•=------------------------•------------- -----------I------------- -------------------------------------•---------------------------------- ----------------- --------------------------------------- ------------------------------------------ ------------- s• – ------•----•------------------•---------------- --------------------I------------------------------ - J. _ ~ a - / FINAL^INSPECTION BY: = = M Date rt 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 : Revised W-2100