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APPLICATION FOR SANITATION PERMIT Permit No. --l-. .�.-� --- # i (Complete in Duplicate) Date Issued -..-- i Application is hereby made to the Santioaquin 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. i JOB ADDRESS AND CAT N___-- `----- ------------V_-------•----- ----------•------------ ele -� --------- Phone._------------------_-- ------------------- -------- Owner's Name------- ------- - --- ---- ,. .,.,4 -«, ---------------- --------------------------•- ------------------•- ----------------------- --------------------------------- Address----•�------------= •- -- - --•-------- _ - 1 �_ --------- Phone----------------------------------- Contractors Name-----= ------ - , Installation will serve: Residence Apartment House o Commercial E] Trailer Court ElMotel ❑ Other ❑ Number of living units: _�..__ Number-/ �of bedrooms _:.Number of baths __�-__ Lot size _. - r�-�•----- Nr; Water Supply: Public syr#errs o*munity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3.feet:l Sand ❑ Gravel ❑ Sandy•Loam ❑ Clay Loam ❑ Clay El Adobe Hardpan ❑ _ ' _Nom Previous Application Made: Yes rNo New Construction: Yes ❑ No ��FHA/VA: Yes ❑. i l TYPE OF INSTALLATION AND SPECIFICATIONS: ?, (No septic tank or',cesspool permitted if.public sewer is available within 200 feet.) .�n .. Septi ` Tank: Distance from nearest well---------------- Distance from foundation---..__.-----------Mater ial....._-_______....___________._____------____-- No.-of,'cornpartments--- ---------------- Size------•--------------------- ---Liquid de th--------------------------Capacity-. k / - 4. l r / ' isp al Field: Distance from nearest well,-_-.._-...-._..Distance from foundation....................Distance to nearest lotrl/ir<e_-.._...,..._.__. of Nu_mber of lines------ ----------------------- .-Length of each line._.:------------•Width of trench.---O ?-_-------------------- De th of filter material-----1f..__._...-.-Total length---------4__e9-------------------- Type of filtertmaferial_/ p Seepage Pit: Distance to nearest well_----- 4---...__DistaRe fr m fou ation..._____�._..___ ��e to riearest lot Ike--�............. I' W,. Number of pits---- --------------Lining Linin materiall. �5ize: Diameter-------- -----------_-Depth-..-- -------------------- Cesspool: plea isfnDiamete.nearest'well_..- YDepthce from foundation-------------------Liquid Capacity.___._--- -.-._.._---`---gals. �. El . - --e ---------------Distance from nearest building-------------------_---------------------' 4� Privy: Distance from nearest well----------------------- ---------------- Distance ----- - , 1 ❑ Distance to nearest lot,line------ = l" Remodeling and/or repairing (describe):._----------------------L------------ . -------------------------------------------------- -------------------------- --- - -----------------------=------------- ------------ ---------------------------------- ---------------:------------ -- - - - -------------- --------•--------------•------------ --------------------------- _ I hereby-certify that i have prepared this application and-that the work will be done-in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 /f� �I Contractor) ' 1i� "....----- =--------------------- (Signed) - ( C or ----- ---------- -'---------- s By:----- -_------------------ ------- = = �J' ------------------------------------- ----------- ----------------------------- - k(Title) . 'n size of lot, location of stem in relation to wells;-buildings.-etc., can be placed on never side). (Plot plan, showing { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. �-------- - - --------------- ----------------------------------------- DATE«'h`— --------------------------------- DATE ' -------- ------- REVIEWED BY--------------------------- -------------------- --------------------------------------------------------- - - DATE---- ---------- I --------------------- DATE____ ----------- - ------------------ BUILDINGPERMIT ISSUED---------- ------------------------------------------------------------------------------------- - Alterations and/or.recommendations:------------._..------------------------------------------------------------------------------------------------------- ---_---------- ------ ---- -------- --- - -- rr�.ar�� ----- r .. .. . .. ........ - -------------------------------- ............................................. . .. _ -------_-..._..---•-_.... ................... r t{ - Dafie_::_ -=` = ----------- -- FINAL INSPECTION BY: = SAN JOAQUIN°LO AL�'HEALTH DISTRICT. r } 300 West Oak Street 132 Sycamore Street 814 North "C" Street [30 South American Street Trac California Stockton, California f Lodi, California Manteca, California y . r E5-9-21x1 , Revised 1-57 F.P.CO.