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APPLICATION FOR SANITATION PERMIT . Permit No. <br /> (Complete in Duplicate) <br /> Date issued <br /> Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS Al, O AT -- _- -- <br /> * t------------ = <br /> Owner's Name.. --------- ---------- --------------------------------------------------------- ----------------------------- ----- -------- Phon . - <br /> Address---------- - -------- •---------------------------- ----------------------- <br /> � <br /> f Phon /p <br /> Contractor's Name.. • <br /> Installation will serve: Residence W-<Partment House ❑ Commercial ❑ Trailer Court [I Motel [I Other E❑ <br /> Number of living units: .-_f-- Number of bedrooms 3.- Number of baths --l--- Lot size --------- ----------------- <br /> Water Supply: Public system El Community system E] Private epth to Water Table .�ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--H-'ardpan ❑ <br /> Previous Application Made: Yes ❑ No W---New Construction: Yes ❑ No Q--� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ptic�T k: Distance from nearest well-----------------Distance from foundation--------------------Material ---_------.------------.-.-----------.-.------. <br /> ---- ---------Liquid depth Capacity <br /> No. of compartments------------ Size G p. ... <br /> "Poib <br /> Distance from nearlst well _ Distance from foundation---l-aJ-.----.--.Distance to nearest lot line----/,0...... <br /> Number of lines----- -- } Length of each line d -----------Width of trench.--- c �'/.............. <br /> ,� Type of filter materials t4-C Depth of filter materiaL.-.-.t "'.......Total length---�Q-------------------------- <br /> of <br /> Seepage it: Distance to near-t well_/—_r- Distance� m und- 455-45------ Distance <br /> _ D�ijstQancIet to nearbst lot 5line­-l6-r <br /> -----Dept h...cd ---------------_- <br /> Number of pits. --- ----.-Lining material-tory <br /> aterial- . -.-- Size: Diameter <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-..---- ----------.Lciniinng material--.--------:._-----.-_------__----._-. <br /> ❑ Size: Diameter-------- -----------------------------Depth----------------------------------------------------Liquid Capacity--------- ------------------gals. T, <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----------------------------------------.-. <br /> ❑ Distance to nearest lot line-------- -------------------• --------------------------•------------------------------------------------------------------------------- Q <br /> Remodeling and/or repairing (describe)------- ----------------------------- ---------------••----------------------------------------•-----------•---------------•--•--------.-. ---------- <br /> a+ <br /> -----------------------------------------•----------•---------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- <br /> ----------------------•----------------------- ------------------------------•-•--------------------------------------------------------------------•----------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--- - ------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> DRAY &NIGHT <br /> Contractor) <br /> Kbuil <br /> -------- <br /> (Signed ------- ontrac <br /> )--- . a � --------• ------�pirc--T,anlc--Service------------------------ ----- or <br /> .,. -- ---- ----- Title---- <br /> Y ii 2 --- - -F.idomd-- H-- -7G_ G <br /> a (Title) <br /> [Plot plan,`s s ing size of lottfb`Ct�if� olIsy'stem in relation tows, etc. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> RAPPLICATION ACCEPTED BY---- ---------------------- ---------)f17:1�- �- .-.----------------- •-------- DATE.-------- �f� = J f�------------------------ <br /> EVIEWEDBY----------------------------- -------------------- - DATE--------------- ------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ <br /> Alteratitms�/a recommendations----------------------------------------- ---------------------------- <br /> �--" ----------------------------------................................................................................ <br /> ------------- - --- --- - - ---• <br /> ifs/ ------- ._ C- _ - ... <br /> Id,-- <br /> -------------------------------------- -------------------- ------- --------------------------•----------------------------•--------------------------..------ --- ----•------------ <br /> ------ = --- - ----------------------- -------•------ ------------------------------------------- ---------------------------------•----------------------- <br /> ------•- <br /> S <br /> FINAL INSPECTION BAY;.: -. j�°"f�-- ---------------------------------- Date ------ ------- -------- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-21A 145446 ATWOOO 12.54 <br />