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APPLICATION FOR SANITATION PERMIT Permit No. .. {Complete in Duplicate} Date Issued .�1.f1 _9----•- Application ii hereby made to the San Joaquin 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. t `i'_." _,« ,,.-�- ------------------ JOB ADDRESS AND LOCA ON-- ------- s� Phone --•--- -------------------- ------------------- Owner's Name ------------ -•-- - ,~ 11 Address. ': -------- -------- =� --------------------------------------- Q - ------------------------- Phon / f� Contractor's Name--------------- - •-�----------I'---- � ---------------- Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment. Douse ❑ ❑ ✓ Lot size Number of living units: j---- Number of bedrooms .- Number of baths _ ._ r --------------- Water Supply: Public system Community sys+em*2f�P-rivate-2,;.Depth-to.Wafer To s ble ft. !vel ❑ Sandy Loam ❑ Clay Loi m E] Clay ❑ Adobe Hardpan Character of soil to a depth of 3 feet: Sand [I I Gr ❑ Previous Application Made: Yes ❑ No New Construction: Yes E] 1-1 No FHA/VA: Yes E] No [ITYPE OF INSTALLATION AND SPECI CATIONS: Fr }y (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------------ ---Distance from*foundation----------_---------Material--- --------------------------------- ----•-- ti i `� N Liquid d'epth--------------- ----=----Capacity----------------------- ❑ ante from nearest well_______________ Distance from s No_. of compartments Field: Dist 1 . Length of each foundation_____-___I_-__-"__.Distance to nearest lot line_________________ Number of lines - g ach line--- --------------- Width of trench----------------------------- ❑ th of filter material--------------1---------Total length----------------------•------------- .. ` Type of filter material____-"_.__-_ --- -� �- p / J � \. Distance to nearest well--�f�lla pistante om f nda+ion__J____ .-----.Distance to nearest lot line__ed------ \` Seepage " `� g --Size: Diameter Depth r Number of pits-------/----------Lining material_,__ m _^ es ool: Distance from nearest well----------------- from foundation....................Lining material--..____..-._--___------------__"als. r Size: Diameter --------------Depfh-------------------------- ------------------------Liquid Capacity 9 Privy: Distance from nearest well___.F--------------------- ----- Distance from nearest building_"_____-------------.-------------------- ---------------- Distance to nearest lot line____________.____"-'_____________________...... --------- ----------- ❑ I Remodeling and/or repairing (describe)--------------- --------------------------------• ------------------------------------- -•---------------=------------------- --------------- ---------------------- ------------------------------• ; -- ----------—---P------------ -------------------------------------- ------ - will be done I hereb certifythat l have prepared this application and ththe wo Health l7is done in accordance with San Joaquin County ordinances, yo'ate 'laws, and r,.les and regulations of the San Joaquin Localf r +r i t it ` act 5i ned --- ------------------------�-----i '- and/or ntr ) :-- ner d/o Co [ 9 } , 13 f� - .+_(Title) [Plot plan, showings a of lot, location of s ste / in relation to wells buildin s, etc., can be placed on reverse side}. r FOR DEPARTMENT USE ONLY ' r DATE_--------1-- I APPLICATION ACCEPTED BY If--: ----------- - � - DATE REVIEWEDBY----------------------------•----------=---- --------- ------ DATE----------- ----- BUILDING PERMIT ISSUED-------------------------------------------- ---- -------------- ------ Alterations and/or recommendations:----------------- „—,_;_r _----- ---- ==---------=-------- ---------- -----------------------------•----------- �� -- f r...- ------- ------ ----------------------------------- --------------------- -------------------- ------------ ----- ---------------------------------------- ----•-"------------------- -------------------------------------- _ -.. Date t 5 S ` ---------------- ----------- ------------ FINAL INSPI CTION -BY:- -- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Tree California Stockton, California Lodi, California Manteca, California y ES-9-2M Revised 1.57 F.P,CO.