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APPLICATION FOR SANITATION PERMIT Permit No. (complete in Dupli�rate} / Date Issued ___ _� __ 14 Application is hereby made to the San Joaquin Local Health District forpermit to construct and install the work rel rite compliance with County Ordinance..No. 549. This application is made m. _ � JOB ADDRI SSA LOC+TION:. - 0 _ "" ---------- f. t Owner's Name- ---- ---- - --- --•-=-- -------- ---------- ^ =-------`-_.------------- ---- -----------------------=__ ----------. Phone. os _:--"— ..---- --.. � . ��. Address ' � - - ----- ------------------ — -------- --------------- ---- Contractor's Name_-` = : .._..---- i Phone. Installation will serve: Residenccee ,Apartment House ❑' Commercial -El Trailer Court ❑ Motel ❑ Other F] 1 ,. :. J. �y.}�.i a Y..T _ _y. - a , : •• ��++ I 1 umber of living units: __'-+-Number of bedrooms Number f baths _1____ Lot size _7o5 ___ ---___. N l b .4.F.-_•. r • .. �,� 1 Water Supply: "Public!, stem- '- Communiit system P.rivafe` De .th'to�,Water Table'". ';ft Character of soil to'a depth of 3 feet: :Sand Gravel ❑ Sandy Loam. Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan EJ "-i s Previous Application Made:-Yes E] No New Construction: Yes No F1FHA/VA:Yes ❑ No TYPE OF INSTALLATION-AND SPECIFICATIONS: S (No septic tank or cesspool permitted if public sewer is available within 200 feet,} Septic ank: Distance•from,nearest wel159-:--- istance � froroundation_ _ .Mate a]- �_ -------- e ph--- ---'No. of compartments--_-------2! Liquid -----------`Capacity----L� v- ---- -fro --. Dispose field: ;Qistance from nearest welt _stance-frorri,founda't�;on l _ Distance to nearest lot)i,ne_t__4+t�--__�'�'' ` Number of lines=_:__°-_____ ____ 'Length of reach IinegT�V�a'+9�Width of trench.,___.__-'X,�--" " of filter materiaflip'- t� '-D£pth of filter material_.______�_ __.__Total length__5____-_ ---------- Type Seepage Pit: , Distance to nearest well____.__._____.______Distance from foundation---_____----------_.Distance to nearest lot line-_.___:._____--_. ❑ Number of,pits{_�J------- ----- Lining cmateriai--------------:-.-----Size: Diameter'-------'- -------.Depth--`-------- ` Gi Qistanco 'from nearest_we esspoolll____: _____._-Di;tanL8-from`foundation-----------______.Lining material-_ _ , ______________________'_________. ...- 'Size: Diameter .'f.--------= - - i - ❑ yy Depth = Liquid CapacifY ------------= gals. Privy: -Distance from-nearest well----------------------------- #---- -------- Distance from ;nearest building _ -------------------- ❑ .. r —Distance to nearest;lot1line----- _ ._ . ,�,�. - 1 .__ . . =` ` ----------------------- Remoc)eing Snd/or repairing (describe) -- ----- . ---- -- - - -- ;--- _-------------------- 4-VA-e!-- -- ..... ---- i r ---. -.--------- ------------ - -------- ---------- =.- =----------------------------- --------------------------------------------------- ------------------- I hereby certify„that,l hove prepared�fhi applicafion and that the work will be dene'in accordance with San Joaquin County ordinances, State laws, and rules-and regulations ofkthe,,San Joaquin Loc`alhFie lth District. (Signed}.._ E-2 --- - ---- - (Owner and/or Contractor) .�`. ---- ` By: , +� � location te�in .relation to wells buildings,s,--etc., can 6eie)-laced on reverse side). �-----_""--"""-"•-"- -------------------------------------------------- ---- ---- ------- -- = (Plot plan, showing size of lot, loco y g p ) { FOR,DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY_.. :.- �- : 4 - , -------------- ATE----------- `-----------------------•--- REVIEWEDBY f — t -=---`----'-- = -- --------------- -: _ DATE_-V------------------------------------------------------ ... - -�-- 1 BUILDING PERMIT ISSUED------------------------------i s -----" DATE-- ---i?fkt---------_!-- - -""-- _-- AlterSfjionsea#nd%o;r recommendatij ---_-------------- -'- ' ------- I------ - I l d ---- --------------- ----------• ------------ NALMENSPECTIO �•BY:__�_w.- --"�'-`.�=-`=-=-----'="-- ----- ----------------------------------------------'-='---------- ` 1 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 E5-9-2M . Revised 1.57 F.P.CO.