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3 APPLICATION FOR SANITATION PERMIT Permit No. . _ (Complete in Duplicate) ,Date issued Applical'ion is hereby made to the San Joaquin Local Health District for a permit to construct and instal1 the work herein described. This application is made"incompliance- with County Ordinance No. 549. ` I. _ j [pc c� . �w y- 4 •.r i .. JOB ADDRESS AND LOCATION---=-1--------9----- -------------��' --- '-----=-------------------L-------------..-..-------------- Owner's Name---------01- --- '* hone--- ------ --------------------------------------- ��5 -- - -------- - Address �� '/ - - --------------------------------------------------------- -------- -------------•--------------------------- Contractor's Name -- - '-----_- =>- _. Phone__ Installation will serve: 'Residence PK Apartment House ❑ Commercial E] Trailer Court E] !Motel E] Other Number of living units: ,�__ Number of bedrooms ___�_ Number of baths ._�___ Lot size _____ .�_ r;----- -_._____-------------- Water Supply: 'Public system E]' C6mmunity'system ❑ Private X*Depth,to`Water Table --YQ_ ft. ` Character of soil to a depth of 3 feet. Sprid ❑ .Gravel ❑ Sandy .Foam ❑ -Clay-'!Loam ❑ Cay ❑ Adobe :-Hardpan ❑ Previous Application Made: Yes ❑ =Nor[ New Construction: Ye Nor❑ TYPE+OF INSTALLATION AND SPECIFICATIONS: 3 (No septic tank or cesspool permitted if public -er is available within!200 feet.) -. ,... - - _._.. Liquid depth--------_,1. p Nci. of compartments--------------------------Size al -- a - cit = tic nk Distance from nearest well------------ ---Distance front•foundation._:_-_________ Maters o , p ` ..,_, I ` DistantCapacitY JU Disposal 1 lel Distance from nearestf well__�r_-_o______Distance from foundation._ a to nearest lot line-----s ....... Number of lines,A I J __._ --------'Length-of each_line_1---- ` r------Width offrench------�-y_"._.___.________ Type filter material_ .i ._-De Depth of filter mt """1 r Yp p ate 'al _ --- `Total length- --�a 4 t See a e Pit: Distance to nearest well__-_____ Distance from'fo i+ c � N r � 1Sa . { .n r. .. .. ... ... p g � � _ _._ � ��nda�ihon__ �'._______.Distance to nearest lot line_________________ ❑ Number of pits_-.-------- g `— ---- p ` - } e:dDiameter _ _ Depth - ----- --------------------- I 1 R i f_:___ Linin material__ __. Siz Cesspool- Distance from,nearest well----- `__-__ _Distance from fouK%t'ionf?---- ----------Lining mafierial__-_ ._----.----_-_--_-----___ _--_-_ ❑ Size: Diameter------------- -------- -; --Depth-------- : =` -� -- r----Liqui8 Capacity--------------- Privy: :gals. Privy:- Distance from nearest`well----------:.*----------------------------- _,____.,.Distance from nearest Bu,ilding-_:----------------------------- __-_ - _ .r ❑w,� Distance to nearest lot fine-,�-- 4,._ ------------�-: --------F----------�• ------ ------ -'�'----- f�_...-----_ ---'- -•----A-------- Remodeling ---- - Jelin and/or repairing describes:_ _� ._ ------------------------ - Remo -----••---- ¢ � - J ------------ - f E _ r 7' - ----------------------- --------------------------------- --------- --- ------- - --------------------------------------- a-� -- ------------------------------ ------' -------- -- ------ ------ - I hereby-certify that I have prepared this application and that the.work will be., one in accordance with San Joaquin County ordinances, State laws, and rules and;regulafions of the San Joaquin Local Health District. (Signed) $ M_ ---�- ~ - -- - ----Owner and/or Contractor ti { /� ) --- --- ----- . - , � { By:------- � .:.L f✓ - - ---- ---------------ETitle')F� (Plot plan, showing size of,lot, location of sysfem in.relation to wells, buildings, efc., can be placed on-reverse side). 1 V j FOR DEPARTMENT USE ONLY # , APPLICATION ACCEPTED BY = " 'i� DATE--- - • } REVIEWED BY ' ._._= _ -- --- DATE----------------------------------------------- BUILDING -------------------=--------------- -•-- -- ---- -------` BUILDING PERMIT.-ISSUED-------------------------------------------------------------=--------------------------------------------- DATE--------------------- -------------•--- i • ------------------- Alterations and/or recommendations- ----------------------------- ------ ----------------------- -----------w '---- ------------------ -- --------------------------------------------------------------------------- -------------...---------------------•-----•------------------------•--------------------------•-------=--•--------............. a i - --------------------------------------------------------------, -- •------------------------------------------------ ------ ___._-______-----------.----------------------------------------------------------------------------- FINAL INSPECTION-BY:-' _.'...:'1__. (. _--------- 7--:-- --- '_ n . Date A. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street S+ockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised W-2100 ,