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APPLICATION FOR SANITATION PERMIT Permit No.,�_.- --- (Complete in Duplicate) Date Issued . - -- � CO� f� 0170 -40 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- 44, g JOB ADDRESS AND LOCATION-_--___ _ ! A r Owner's Name_ ----- 4--4`d�- - ---------------------------------- - Phone_- 1"Lt¢/_ ? 1 - = ------- ------------------------------------------------------------------------------------- Address ------ -- Address----------------------------------------------------------- A _ '� ----- Phone L�=��C' Contractor's Name___________________ s_ *- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -`-------------------------------- Number of living units: __r___- Number of bedrooms _1 Number of baths -_f____ Lot size ___ - --Z-A � - . Water Supply: Public system 17 Community system ❑ Private Depth to Water Table - -eft. Adobe Hardpan, Character of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loom F1 Clay Loam [IClay E] Previous Application Made.: Yes ❑ No°JRL New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Material--- ---------- ----------------------------- �. ptic Tpnk:. Distance from nearest well----------- --Distance from foundation-_----___-_.---- -. No. of compartments ----------- ------Size-----------=--------------------Liquid Opf --------- ------------Capacity-------------------- r .�- --.Distance to nearest lot line-- Disposal Field: Distance from nearest well t5_0------Distance from founn ation.__ -__ Length of each link-2 ----- -Width of trench _-- - f s Number of lines-------/--------- i1 g ei • � � -4e th of filter material-___ -_Total length__��___------�-G�--?-f�------- - Type of filter material---f-3-----------� P - k .s �Qf l.D3s#anc�to nearestgt lisar_ _- ---- - ' Seepage Pit: Distance to nearest well_ --__-_ Distance fr�mnafion___ _ Depth-2-4---------Number of pifs-__------�__-___---Lining material_--� Size: Diameter--------- ---- - Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Capacity gals. ❑ ---- q p Y Size: Diameter--------------------------------------DePth-----------,---- ------------ ------- ----- -------------------Distance from nearest building---------------_-------------`---- Privy: Distance from nearest well----------------------------------- ,. •�. . --. ��,��:9""-- ----------------------- --�—Distan-ce-to--nearest lot line--r-_=__-__- Remode m and/or repairing (describe):__s_--- -___ --•---------------------- ------- ----------------------- ----------------------------------------- ------------------------- ---------------- --- - - - ---- ------------- ------------------------ -------------- ----------------------------------------------------------- -- - I hereby certify that I have-prepared this application and that the work will be done in accordance with San Joaquin Dun ordinances, State laws, and rules andV-egulations of the San Jf oaquin Loc I)Health District. --!-- � --=^---- --------------------; C n+recto (Signed) � _ Bye =� - ` ------- (Plot pian, show g size of lot, location of sys+e i�tion to wells, buildings, etc., can be pla on reverse side). 1 FOR DEPARTMENT USE ONLY DATE--- APPLICATION ACCEPTED BY- .__-- ----------------------------------------------- REVIEWEDBY --- - DATE-------- ---------------------------------------------- BUILDING PERMIT ISSUED-------------- --- ------------------------------------------------------------------ DATE--------- ----------------------------------- Alterations and/or recommendations----------------------------- - ------------------- ------ ---------------------------------------------------- ---------------------- ------ ------------------------------------------------------- ------ - -------------------------------------- --- - - ------- Date---- -- -- ------------------------------- FINAL INSPECTION BY:- --- -_-- ------------------------------------------------ - ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT k 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y € ES-9-2M B-51 Revised W-2100