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APPLICATION FOR SANITATION PERMIT Permit Nc ->11*'ff___. (Complete in Duplicate) S'/ Date Issued r 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. JOB ADDRESS AND LOCATION------- �` -B't Owner's Name----------------------=----------........ ------ ------�5 ' - - -- Phone___.3'__��-��-- ------ .1- ------------------------ ----------------------------- Address----------------------------------I------..... 4 ---------- --------------------------------------------------- Contractor's Name.. = fi " JC, -- ----'--=------------ ----- Phone- SI O Installation will serve: Residence E] Apartment House ❑ Commercial ❑ Trailer Court E] Motel ElOther ❑4,fw-A Number of living units: ---#_ Number of bedrooms ---�- Number of baths . __ Lot size ___C9 ' _ -____. --_________.____ Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table i/O_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,A Hardpan ❑ Previous Application Made:' Yes ❑ No 0 New Construction: Yes ❑ No ❑� ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tic Ta k; Distance from nearest well-----------------Distance from foundation-------------------.Material_____________________--________________________- �,,.c No. of :compartments--------------------------Size---------- ---------------------Li uid depth--------------------------Caacit V ' Disposa� I FieN- -Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line-----------------I IN Number::oflines-----------------------------------Length of each line------------------------------Width oftrench----------------------------------- (A Type of.filter material---•---------------------Depth of . 'al-----------------------Total length-_-------------------------- ------------- Seepage Pit: Distance to nearest well-Alow-)---CDisfance nce fro��??��foun a,tio ..�.A_ ____.Distance to nearest lot line__,_ -_ Number..of its____ _ .... rr � °� p --------------Lining ml-____ -- - - ___Siz Diameter__-_ -- Depth__, '-___________-__--- ' Cesspool: Distance from nearest well-------_--------- from found io ------------------_Lining material_______ ____.._____________---_____. ❑ Size: Diameter------------------------------------- h--------------- ---------------------------------Liquid Capacity-----=--:.. g Privy: Distance from nearest well----------------------------------------.--------Distance from nearest building____.__-_____________-..________________- ❑ Distance to nearest lot line----------------------------------------------------------------•--------------------------------------------------------------------------- .. Remodelingand/or repairing (describe):------ ---------------------------------------------------------------------------------------------------------------.---------------------------------- ----------------------------------------------=----------------------------------• ----------------------------------------•----------------------------------------------------------------------------------------- -----------------------------------------------:-------------------------------------------------------------------------------------------I...------ -----------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ or -=-------•-------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------_------------------ dinaI hereby certify that I have prepared this application and that the work will bejone in accordance with San Joaquin County r ned}nces, State laws„�and-.rGTes and regulations of the.S oaquin ocal Health bistrict. l ° ( 9 _- -- -------- ( r Contractor) BY = = ---------------------------------------------- �Q__R------------ (Plot plan, howin size of Io't, Iocation o ys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY REVIECA710N ACCEPTED.gY 10 - ------ DATE-------- ------- -- - WED BY---------------------- - DATE ----------------- --------- --------- ------------- - -. BUILDING PERMIT ISSUED-------------------------------------------------=---------------------------- ---------- DATE _ Alterationsand/or recommendations------------------------------------------- ------------------------------------•------------------------------------------------------------------------------ ------------------------------------------------=--------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- ------------------------------------- ----------I--------------- -------------------- ------------------------------------------------------------------------------------------ -------------------------- ----------- ------------------------------------------------4-------------------------------- - --------------------------------------------------------- FINAL INSPECTION BY::gI ' t� ..w� _� --=----- --------------------------------- _ Date_ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1310 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M &51 Revised W-2100