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VY", ev y APPLICATION FOR SANITATION PERMIT Permit No. .-. 5r�________________ "•(Complete in Duplicate) Date Issued � c�3 Application is hereby made to the San Joaquin Local Health District for�a permit to construct and install the work herein described. This application is made,pincompliant with County.Ord.i ante No. 549.1 � . . IFU_SQ 7iO.SY.F � r r JOB ADDRESS AND CATION. Owner's Name------- ----- r------ ----- -- - ------ ------------ --------------------------- Phone. ---- Address-' --- Address lAk-------- --- ----•- ------------------- ----- - -. -- - Contractor's Name---------------------`--- --- ----- - ---------------------------------`--- ------•---•----- Phone.__ - Installation will serve: - Residence- Apartment House ❑ Commercial EJ/Trailer Court ❑ Motel ❑ Other E] Number of living units: ___ _ Number of bedrooms _-_-__, Number•of baths!_:-. Lot size _,34--c --------------- .r Water Supply: Public system '❑?Community system ❑ Private Depth to.Water Tables: ft. Character of soil to a depth of 3..feet: Sand d,1. 'Gravel ❑ dandy Loam ❑ °Clay Loam :❑ Clay ❑ Adobe ' Hardpan ❑ Previous.Application Made: Yes ❑ No r New:Construction: Yes ❑t o FHA/VA: `Fes ❑ No ❑ " TYPE OF INSTALLATION AND SPECIFICATIONS. r (No septic +ank or`cesspool perrnit+ed.if`public sewer rs available within 200 feet.) Se is nk: , � nearest ,......_� . _.. .- ,A_. Distance from ' we4i --:---_-----:.:J-Distance from foundation___-.--------------Materia#-----_--___-_--____-_--__-_-.-__-_..---_--.-_-, Liquid de th----------------.-_-----.-Capacity No. t comport�en�s---•----------- ----�..._�5ize----�-----------------0------ - a P --------- --- --�---- Disposal Fi Distance from nearest well _______Distance from foundati n__.l!`d ._yls rhe to nearest lot line__>? Number of lines'--__ _ Length of each lin --- �� .___Wth of trench.._ _- --------- Type -_ �_ 100 T e of filter material-_ ��__Depth of filter matenal____� _--___..._.Total length------ Seepage, _____ ► Yp ! �._ , See a e Pit: lD�llumabee of nits rest well -_� p g .____.__.__*Distance from foundation-------------------.Distance to nearest lot line----------------- S ❑ p' #Lin_ing material-----------------------Size: Diameter- ---- Depth--------------------------------- Cess 1oai: Distance from nearest. { 3 p well______ ,__Distance from foundation-----_-----_-------_Lining material_____ ._.___--_____________-______. h . ❑ �: -- -----------Depth---------.------------------------------------------Liquid Capacity----------------------------gals. Size: Diameter_=_.__`_______________ r Privy: Distanc�e' at ` l =------------- --------------------------------Distance from nearest building------------------------------------------ Distanceto eaelotI�ne Remodeling anp/or repairing (describe):-------------------------------------------------------•-•--------- -----------------------------------------------•-------- i fA. A ------------------------------- --------------------------------------------------------••------------- ------------- ------•--•------------------ -------------- ----------- -------------------------------------- i• ! ; ;, A i ----------------------------------------------- p P- -- - - pp-- -------- -------•----------------------------------------•-----------------------------------------------------•-------------- I herebycarti at 1-have prepared this a licetion and4at 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. (Owner Contras (Signed)------------•---v- ------------------------ --� -:--, �-------- -- --- ------------.-.- ------------ ------- -- ----- -- - --(Ow and/or tar) BY� ._... = 11�� .......................... --------------------- ---{Title)------- 'f--`-----------•--------------------------------- (Plot plan, showing size of lot, lata+ion of sysfem in.re ion to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY REVIEWED BY R.f :._-.:fi 't -0-.,� -------------------------------- DATE - - APPLICATION ACCEPTED BY__.- -------_- >� ----- --- -- �-'��----- ----- BUILDING PERMIT ISSUED----------=---------- Y ��--�--6- -----) ------------------------------ DATE--------------- --------- -------- -------------------- l Alterations aid/or r corn erida+ionsi------------- ---- --------------- ------------------------------F- --- ----------- --- - --------------------------------------- . a = - L -=---------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.-2--- - _= - :--:-__ Date. ---------- ------------ 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 ft ES-9-2M Revises 1.57 F.P.CO,