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5 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date lssuedj��__a------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'install the work herein described l sligation is mad yi m C Ith County Ordinance No. ( 1 N- -,z T app I X2 Z- '7, JOB7DDRESS AND LOCATION.------ ------ ------------- ----- Phone-----------------------••------•---- Owner's Name_-___--_._ -- -- -------- ----------------------------- ---- -------------------------------------------------------- -- ---- -------------------------------------------------------------- Address------------------1�- - --- - ------- --- ------ Phone----------------------------------- Contractor's Name________________ - - -------- ---- -------------------------------------- Trailer Court [I Motel 0 Other 0 Installation will serve: Residence [� Apartment House ❑ Commercial E] ............ rooms -%S- Number of baths Lot size ------------------ f: _ Number of living units: _1--- Number of bed Water Supply: Public system 11 Community system D Private F7l Depth to Water Table __f,* ft. --Flardpan 0 Character of soil to a depth of 3 feet: Sand F Gravel [:j Sandy Loam 0 Clay Loam [I Clay E] Adobeja --No Previous Application Made: Yes El i No R_-New Construction. Yes gg--No E] FHA/VA Yes'Z; El TYPE OF INSTALLATION AND SPECIFICATIONS; available within 200 feet.) (No septic tank or'cesspool permitted if public sewer is *4 Mat cQ hom foundation la--------- ,e�a Septic Tank: Distance from nearest well----re)-_-Distan If acity----- ui� clpfh---'�ej�------------Cap -ornparfm' enis----- 2------------- --Liquid No. of c nearest lot line...4:v-------- Disposal Field: Distance from nearest well----tlff---.-Distance from founclatio ------------- Distance to ----- ---------- _017` ------Width of trench ____+------Length of each line Number of lines- .... Depth of filter material_- -------------Total length------A 01 ------------------ Type of filter material/ - ----- ---- D�stance to nearest well-.-/40P d ion-------W---------Distance to nearest lot Im le------ Seepage P ------Distance m fo at %-., &- , 0�) ----Size: Diameter- --------Depth------9--- ------------------ Number of pits------ ----------Lining material A_MV4f0_/-1 Cesspool' Distance .from nearest well-----------------Distance from foundation--------------------Lining material__-__..__----------------------a Size: Diameter--------------------------I------------Depth-.--------------------------------------------------Liquid Capacity----------------------------9 s- ❑ ..4 __-__Distance from nearest building----------------------------------------- Privy: Distance from nearest well_____ ----------------------------------- 0 Distance to ----------------------------_--_--I------------------------------------------,--------------------------n_-e-_---a-.---r-e--st-lot of-line------------------- 1ne-------------------- _----------------------_-_----------- ------------------ -----------------I- - I Remodeling and/or repairing (describe):---------------- - - ------------1-------- ------------------------------------------------1---1-------------I----------------------1----1-----I---------------------------- ------ --------------------------------------------------------------------------------------------- - - - ------------- -- ------- --- ------------ ------------ ------------ ----- --- ---------- ----- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County------ ----------------d --------- anI on f th -I ordinances, State laws, and rules I egu tions 1 5 San Joaquin Local Health District.0 q CWP,"FiJli4orContractor] (Signed)----------------------------------- ---(Title)---- --------------------------- (Plot plan, showing size of lot, loc.aBy:------------------------------------------ ------------------------------ -- of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ---------------- DATE - ---------------------------------------------------- APPLICATIONACCEPTED By_ ----------------------------------------------I------------------------ --------------------- DATE__;Z>----------------------------------------------------- IIREVIEWED BY-------------------------------- ------ ---------------------- ------------------ ------------------ DATE____9A—-------------------------------------------------- ....... ------ BUILDING PERMIT ISSUED------V------------------------------------------------------------------------------- --------- ------------- . .....- ------ ----------------------------- Alterations and or omrnendat&ons:__.i._,. � 0 -,,/ --ij ----------- --------- ... ------- ----------------OW ----- ---- ------ ---------- ------------------------ ------------------- --- ------- ----- -------------------------- --------- --- ------------ _h- �av --Pbl-Aw- --------------- --c-----------'--_ - -- --------------- -- ------- -------------- ------ --- ----------------------------------------- ---------- --- - 7 - ------------------------------------------------------------------------ -------------------------------------------------------- --------------------- -------------------------------------------------------I------------- ------------------------------------------- FINAL INSPECTION BY------&�_ ---------------------------------------- Date....-.__._.- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 sycamore Street 014 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y, -N _Fyiur ES--9-2M Revised 1.57 F,PCO.