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APPLICATION FOR SANITATION PERMIT Permit No. ----- (Complete in Duplicate) )/�Zj Date Issued --A Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This r<f/C��uJ mpliance.with County Ordinance N�549. OSS- rcfy_ Z. JOB ADDRESS lication 1ANDat iCcompliance. Tai /f PPS'( A ---------- l' ._ ,r ION-- - ------ ---- = -- -------------- Owner's Name � -- --------=---- Phone------------------------------------ —J _ �� / P Address---------- ..05� �� = ' !"�- --Z-<- --------------- -------- ----------------------- Contractor ---- s Name = rte"�-1 � � Phone---------------------------------- f Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ Number of bedrooms ^__ Number of baths __f__ Lot size ____ a �`-c:—-- Water Supply: Public'system ❑ Community system .[] Private ❑ Depth to Water TableL'i-7. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay,❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 29--'-New Construction: Yes 9"`T07❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a Septic Tank: Distance from nearest well_Z��__ Distance from A`rfdation----- Z...____.Material____ No. of compar#ments:____.a __ ----------*.$ize_- ---, ---Liquid depth--� --- ----------Capacity---� _UrR---• Disposal Field: Distance from neares well f✓ __.._Distance €rom foundation-_/ _.______-Qistance to nearest lot line__ _______. Number of lines___._ en th of each lin ®� ............... . .... 9 �.�1-�• �"_ ��-_Width of trench----- -_l�___'� e -� -- f - --------- Type of filter material-_f �_--_ epth of filter material___-/..`.!......Total .. �y, I Seeps e Pit: Distance to nearest well---- _ d/_.______DistanC from foundation__--_��.---------Dist ace to nearest lot 115e_____4______. Number of pits...�------------Lining materialt ._. e: Diameter__. .__.__...__.Depth_..-Q,--------------- Cesspool: -__--____--_Cesspool: Distance from nearest well_________________Distance from foundation................... Lining material---_--..._.__,_____._______________. ❑ Size: Diameter- --=--------------------------------Depth-----------------=------------ --------------------Liquid Capacity----------------------------gals. \^ Privy: 'ems., Distance from nearest well__________________________________________..-_._Distance from nearest building------------------------------------------- `�1 Distance to nearest lot-line-------------------------------- ------------------------------------------------------------------- ---- ❑ fi Remodeling and/or, repairing [describe):_...-- - a - _____ _ �C ` - !zl__T-_________- ----------------------- ------------ - - � - f ------------------------------------________ _________________________________________________________________________________________________________________________________________________________________________________ I hereby certify that 1-have prepared this application and that 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. (Signed) ------- _ - ?`-- ------- ___, ��L f 1. '_ -- .___-______ Contractor) Plot Ian, showing of--, location of s s elation ---------------------------------- ----- ?efo ,e ------______.-yam (Title)-_- ( p g y o wells, buildings, etc., can be plarevers side). FOR DEPARTMENT USE ONLY k " APPLICATION ACCEPTED BY-------•----- ------------- ------ --- --- -- -- ---------------- -------•---- ---------------- DATE--- ----------------------------------------------- REVIEWEDBy------ k----------- ---- ---------- ------------------------------------------ ----- DATE---------.- BUILDING PERMIT ISSUED -------------------- ---- --- - - DATE--------- - --------------- Alterations -- ----- -•- x Alterations and/or recommendations--------------------- --- --------------------- ,� --- - ------ -------•-------- -----�-------------------------------------------------------------- ------------------------------ ------------ --• ------•---------------------•-•----•---•--------•-•--------------------•------------- -------- ----------------------------------------------------------------------------------------------------------------....... -----•-•--••---••---------------------- - ------ ---------------------------•-•-------------------------------------•------- ------ -- -------------------------------•-----------------------------•---------------------------•---------------------------------------- FINAL INSPECTION11--------- --------- -- -=--•----- Date------------------------------------------------------------------------------• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street- 132 Sycamore Street 814 North "C" Street Stockton, California t Lodi, California Manteca, California Tracy, California \\ ES-9 145446 ATWOOO A t