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--. F y*-- -- - V Permit No. ---_!�.�-�.--_f.,�- " APPLICATION FOR SANITATION PERMIT - , [Complete in Duplicate] Date issued 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 in compliance with County Ordinance No. 549. R JOB ADDRESS AND LOCATION________-V ---------- _�/� ��`-s•-�: ft Owner's Name--------------- ---------- fQt I D ----------------- --- -. ------------------ ------- Phone.- __ ----- r --•----•------- ------------ ------5, 01 --------- Address /�l �2f- ��C/ _ c�' on Contractor's Name--- ----- -------- Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ ❑ Number of baths __. / Lot size ._.___ - -----/--�---------------- Number of living units: -1----- Number of bedrooms __�- f-- - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adgbp Hardpan❑ Previous Application Made: Yes ❑ No X.New Construction: Yes ❑ No FHA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: �„[,No septic tank or cesspool permitted if public sewer is available within 200 feet.) D;stf -- ._tion-------------------Material------------------------------ ----- �rorn nearest ' a No. of eompartme is_well_-- Size_ from founds Liquid depth--------------- ----------Capacity-------------- ------ 1 i j_. Dis I field: Distance from nearest well.--1Qll✓ Distance from foundation__- Q_._-.--Distance to nearest loft lin`�__ _-_____ . Number of lines----_-------0--- -- -----------Length of each line--_----- --9------------eWidth of tTench---- --� `---------------- Type of filter material-. --Depth of filter material.____1c ----.----Total length_____�.?__�------------------•- - 11.!! F �d Seepage Pit: Distance to nearest well___-IV-&�__Distance fr foundation____ �__--__.Distanceee nearest lot line _-r kze: Diameter------3�-------.Depth_.-24-�--------------- Number of pits______ ____________Lining material_______ L�'�$- Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material_____-----____----------------••els. + ❑ Size: Diameter-------=----------------- ------------Depth-------------------------=---------------------------Liquid Capacity -----g Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------------------- ------------------- Distance to nearest lot line.-- --------------- -------- - ---------- ---- - - Remodeling and/or repairing (describe _.___. `- ------------- --------------------------------------------------- ----------------------------------------------------------------- -----• ---------=----,- ----------•-----•--------------•--------------•----------- -=-------------------- --------- -- - - -- -- ------ - - - -------------------------------------------------------=---°------ ---------- ------- - - - I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and rules and re ns of the San Joaquin Local Health District. + -------------------- -----[Ow r ac --- (Signed) rear and/or Contractor) -- --------- -- BY: .............. ---- Tit e) -- --------- [Plot plan, showing ize of lot, location of system in a+ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_---------------------------- -- ----- ---------- ------------------------------------ DATE----"1 ----------------------------------------------- REVIEWED BY--------- -------------------------- ------- ----------- --------- ------------------------------------------------ DATE---- -- BUILDING PERMIT ISSUED---------------------------------- Alterations and/or recommendations---------- -----------,---- -------------------•---•- ------------•--------------------••----•• ---•------- 1 ---•- ------ _ -•----------------------- ---------------------------------- ---•- - =-------------- j FINAL INSPECTION BY---------- -------------- ---- ------------- Date / -- - >----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E 130 South American Street Soo West Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 IFY.00.