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FOROFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.4 _ .� . ----------'- - ------------------------' --------- (Cornplets in Duplicate) ---- ------------ This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND`L'OCATI ON__ ��\. --------------------- -------------------------------- ----- Owner's Name----- Phone i Address-----•---...... ----- --- - - -----`-------- --------- Contractor's Name______ , •�- rL �j,._ C_ = �~; P_hone.7`C� .`� + Installation will serve: 'Residence' Apartment House ❑'yCom�merci'a1+:0`n.Trailer;Court_.`y,❑'\ Motel El Other El Number of living units: Number of bedrooms __'lam•*Numbergof4-1 aths Water Supply: Public system ❑ Community system 0\Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel'0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made:--I4f-yes,-do?e-:.__.-_----.._..-_}I No ❑) New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . h (No septic tank or cesspool permitted if public sewer"is available within 200 feet.) Z 1 I Septic Tank: Disfance�com\ne resf well— Disf6-n6e from foundation--------------------Material--------------------__--.____________ _--_-_--_ No. of compartments€ size------------------ ----- -------Liquid depth--------------------------Capacity---------- ------------ t. °, , ��,� _ Wiz" x.—� i Dis k Field: Distance from neares . well__- -_Distance'Nfrom foundation_____------Distance to nearest lot line__._____ .`1 Number of-fines__"""'--_---__1---- -'`-_-` 4 �� LT �- Lerigth of each line------___-� --------..Width of trench..__.--- - ---------------- Type of filter material__.-._ -�-r _Depth of filter material-_---Cc��__-_____._.Total length___--_.___,'�.,?______________________ s. Dumber of its___,_____ Linin . f Seepage Pit: Distance to nearest well----- _ _-Disfance fro foundation___.�___._.Distan� to nearest lot line___ WOW t material___ Size; Diameter______ ____ p �---- -- g; -- � �� ---Depth-. �/--------------� X ti �A.\\L% Cesspool: Distance from nearest well----______...'--_Distancfrom foundation--------------------Lining material--------------------------------- M ❑ Size: Diameter----------------- ------------ Depth _' . q Capacity---.Liquid Ca acit gals. i '` �---- -- Privy: Distance from nearest well -----------------------A.._ _ _:---------Distance from nearest building---._..._____-.--- .______--__--------- 0 ❑ Distante.to..nearestaof_I]ne_____-= ------------------------------------------------------------------- Remodeling-a rd/or-repairing.(.describe) :--------- - --- � - w `,--�'� � :-_ �` - a 1 �/ -- - -------------------------------------------------------------•-------------------------------------------------------------------------------------------------I------------------------------------------------------------ - I hereby certify that I have prepared this application and that the work will be done,in accordance with San Joaquin County ordinances, State laws, and rules d regulations of.�tfi San Jo quin Local Health District.' F (Signed) Y '.$-" ` ------------------------- ----(Owner and/or Contractor) �_�- - BY: LL ^- -------------------------------------------(Title)------- -- - ----------------------------------------------- (Plat plan, showing size of.lot, Io a#ion of==sysfe in relation to well's, buildings, etc., can be placed on reverse side). � FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY------ ----------- = ---------------------------------- DATE-------------- ---I�-- - ------------- REVIEWEDBY--------------------------------------------- ---- ------------------------------------------- ------------------------------ DATE BUILDING PERMIT ISSUED-------------------------------------------------------------- --------------------------------------. DATE Alterations and/or recommendations:------------ ------------ - ----------------------------------------- -----------------------•---------------------------------- ------------------------------------------------------------------------------ ---- - --------------------------------•---------------------- ------------------------- ---------------------•--------.------------.---------- ---------- -------------- ------------------------------------------------------------------------------------------------------- ------- ------------------------------------------- -------------------------------- ----------------- -------------------------- - ---__------------------ -------------------------------•------------- ------------------•------------------- ------------------------------------------------------ FINAL INSPECTION BY:-._.... � Date � 6 f--------�---------- ------ -------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.a.co.