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APPLICATION FOR SANITATION PERMIT Permit -- ' _ (Complete in Duplicate) N ---- Applicaaion is ltereb M T - Date,Issued a S' y made to the San Joaquin Local Health District for permit to construct and in This application is made in compliance with County Ordinance No. 549. stall the'work herein described. G JOB ADDRESS AND CATf N_,_,__ . t // Owner's Nam f ----- -------' -- - --------------- h Addy //,, ass -------------------------- ---------------!r`-��_�--_ - - -; - ---•- �--- �l �;------ - - --. one __.: Contractors Name ` ' - ---------- -------•----------------------------------------- , --- Installation will serve: Residence LJ _ ----•--- -- ` Apartment House ` " Phone__-.__- ❑ Commercial --•-------------- - Number of living units: ---t---- Number of bedrooms ___ :--- Trailer Court ❑ Motel ❑ Other ❑ Water Su ] - umber of baths _ _ PP Y. Public system JCommunit s . ..... ..� Lot size --------•-- / Y ystem�❑ Private _.r � - ��-,--------- . f, Charac+er of soil to a depth.of 3 feet: Sand Depth to Water• Table __-.__-."ft Previous Applicafiort Made Yes (] Gravel ❑ Sandy Loam ❑ Clay Loam a A- :i. - � L ❑ Cla ❑ No [ New Construction: Yes ❑ -No Clayo. Adobe ardpan ❑ TYPE OF INSTALLATION AND'SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2QQ feet.) S tic Tank: Distance from nearest well . O r •+- • Distance-from foundati No. of compartments ------- --"SizeZC /LJ _.� IF _A - Mat fiai_------ ----- -------- _ # r Dis os Field: Distance from nearest well.- Liquid depth____-___ U -f ------------------Capacity._.-,�--------- . r -__-_Distance from foundation____1�_ Number of lines------------ - ------ --- ----Lengthy of each line--------_- J�_r�G!_-W stance to nearest lot fine___�_ Type of filfer.material_ _ -._ idth of franc -- -r' Wepth of filter material----- __ Seep ge ,t• Di arice to no well :pistance from foundation___a;_ _Dols"tan'ce gtht ` ------ ---------- k f er o s- Lining material_--_-------' c to neares of li�� Cesspool: , .. Distance fr neare well-------------- Distance from 1 -De` th_._ --cize: - -------- « - Diameter_ Size: D' er:'` , , foundation. " ._ - Lining mat r p �/ ramet - -_. De th r f_ q Aerial_ --_ _ Priv `,_. X_ •� __ s'�. ---- � s ---Y-__ • gals; Privy. Distance from nearest i�eli_-_-- .--- Li urd Ca gcrt. _ ` ____Distance from .nearesr building �,ra Distance fo neare-sf lot line -------------------------- __ •.---------------------------- pairing,(describe):and/or repairing,(describe)-------------------------------------------- F ______________ r -•------ --- ----------------------------------------------------- -------•----•_-•------ --- -- i r -' _ _ t -------••-- - •--------- •-- = t' p -------------------- _ _ __ _ " hereby certify that I have'prepared this applicafron and'+hat the work will bie done'in accordance with San J 3 �.... ---------•------ -----------'--------- ----------- •--`--- 0Wnances, State laws,'and rules and regulations of the San Joaquin Local Health District, o. oaquin County (Signed)---/------------ f . ' loca �,onff�.� -------------------------> ---------�- - {Qw8 ner an r Con t frac or) {Title)PIo+ plan, sh wing siz f to+, tem in rela+ion to wells, buildings, efc., can be placed on reverse side). # ti + f FOR DEPARTMENT USE ONLY # ` ! APPLICATION ACCE=PTED BY _______ -- ------------------------------------------------------_ DATE-------- s t- ----------------------- BUILDING PERMIT ISSUED--------- ------- ------- DATE. = Alfera+ions and or recommenda+ions:___-. a�_ - --------._ DATE------------ - _' --- - __ ---- - �- t - j ------------- "--------------- •---•-----•—•------- ------------------------------------------ FINAL INSPECTION'BY:.,-----------------------------." _ ---- - -------------------- —3 ate--- ----------- SAN JOAQUIN,LOCAL HEALTH DISTRICT 130 South American S}reef 300 West Oak Street Stockton, California Lodi, California 132-Sycamore Street v 914 North "C"Street - Manteca, Californfe Tracy, California . E5-9-2M Revised W-2100 r'