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APPLICATION FOR SANITATION PERMIT Permit No. &;g-!F---4-- 4.. (Complete in Duplicate) Date Issued --- This Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'install the work herein described. application is made in compliance with County Ordinance-N-o.-549. JOB ADDRESS AND LOCAT104N------J..1vi ------------------------------------------------------------------------------ ----------( Owner's Name_---- -- --------------- Phone Address------------- --------- Contractor's Name--------A -4 Phone-------------------------•----- installation hone------------------------------------ i------------------------------------------------------------------------------------- Installation will serve: Residence ❑ Apartment House E] Commercial E]- Trailer Court 'Motel El Other E] Number of living units: _F__ Number of bedrooms 1,44.t Number of bath's ---� Lot size Water Supply: Public system El . Community system E] Private 9�Dept6o Water Table Character of 'toil to a depth of 3 feet. Sand ff Gravel [j Sandy Loam E] Clay Loam E] Clay [:] Adobe 8'�Hardpan ❑ Previous Applica4ion Made: Yes [-] No 9�ew Construction. Yes El 'No U?-'1HA/VA: Yes El No Ed.-- TYPE OF INSTALLATION AND SPECIFICATIONS: 5,e (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sepfi��Ta4'-. Distance from nearest weJi------:1----------Distance from found'afion--------------------Material stpW No. of compartments-------- -----------------Size--...' -- ---------------- -Liquid depth--------------:-----------Capacity-------------- ------ Disposal Field: dation----!�I)---------- Distance to neatest lot r Distance from nearest 'well- ��►-----Distance from fo�un Length of each line---------/9---- ---Width of trench. ----------- Number of knes----------/ 4'" 2 Type of filter material--- - ------ ----Depth of fifer'nri'afe'rial------/ --- 4 .......Total length--------/40_------------------------ tj�jDistance to nearest well----/40Y_-_-'�e' �Distance fr m tf/' ndatjon____ --_.Distance to nearest lot line-- -------- g {dumber of pits-_ Diameter_..._- il `" 1:7 de------------ N ---/------------Linin mat6riaL_., _�m- -------Size: v--R-- ---- 4 Ces[S&P0?I: Distance from nearest well---------------- Distance fromfoundation-- -----------------Lining material-----1------------- El Size: Diameter------- ----------------- ----------De'Pth ------- ----------------------------------------- Liquid Capacity--:-----------'.I ------------------ .1 ." i ----------gals. Privy- Disfanc-e-frorn nearest'Well---------------------------------------------------Distance from nearest building-- -- - 1\ Distance to nearest lot line_____----------------------- - ---0 ---------------- �7----------------- ---- ---------------------------------------------------------------------- Remodeling and/or rd'pairing (describe):______----------------- a 0Z--------------------------------------------------------- ------------------------------------------------------------------------------I-------------------------------------------------/-------------------------60----------------------------------------------ff�--------------------- ---------------------- -------------I--------------- ------------------------------------------------------------------------- ------------------------------------------------------- --- - ------------------ ------------------------ ------------------------------- -----------------------------------------------------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, r and - I and regulations of the San Joaquin Local Health District. and (Signed) .................. ----------------- --------------------- ----- --------------------------- ------- --------(�r Contractor) By--- -----------•-------_ --- ----------------------------------- -----------------------fTitle)...... --—--------------------- (Plot plan, showing size of lot, location of s m in relation to wells, buildings, etc., canbe placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- DATE_------ - ----------- ------------ ------------------------------------------ BUILDING PERMIT ISSUED------------------------ ------------------------------------------------------ DATE--------V ----------------------------------- REVIEWED BY - ------------------------------------------------------------------------- DATE Alterations and/or recommendations:--------- ---------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------I-----------------------I----------------------------------------------------------------------------I---------------------------- -------------------------------------------------------------------------------------------- ---------------------------�_11- -------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------%. -------------------------- ------------- ------------- ------------------------------------------------------------- FINAL INSPECTION BY:.-------- ---------- - - ------------ -------- Date------- SAN JOAQUIN LOCAL HEALTH DISTRIC 130 South American Street 300 West Oak-Street' '4" 4 l ik 132.Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1-57 F,P,CO.