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APPLICATION FOR SANITATION PERMIT S Permit No. (Complete in Duplicate) Date Issued ---�0 A-% to construct and install the work herein described. Applica+ion is hereby made to the San Joaquin Local Health District fora�,ermi This application is made in compliance with Count'/ Ordinance No. 549. LOCATION---- 0�r n 70- -------------------------------------------------------- JOB ADDRESS AND ----Tf I -- ---,?---- -- - ----------- -- ----------------------------------------- Phone-_-------------------------------- Owner's N6me------------------------------- ------ ----------------- ------ ------•--------- ;,........------------------------------------ ------rk_�_,__ --------- --------------—----------- Contractor's Number of baths _e Lot size Name-----------------------------------------------------------------25-��........-------------------------------------------- Phone----------------------------------- Installation will serve: Residence.Ij Apartment House ❑ Commercial [] Trailer Court [I Motel L9 r<ther C] - ------- Number of living units: Number of bedrooms'%_9 Water Supply: Public system El Community system E] Private ' Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam 0 Clay Loam ❑ Clay 0 Adobe E] Hardpan 0] Previous Application Made: Yes E] No 0 New Construction: Yes 0 No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) (No septic tank or cesspool permitted if public I sewer is t D - Distance from foundation--.- -_5-------- Ma e Septic Tank: Distance from nearest ------ ---------- ---------- - -----0 x No. of compartments.......f..:�-----------Size-----y--- ----Liquid depth Capacity Distance to nearest lot line_ ---- Disposal Field: Distance from nearest well_!�-�....Distance from foundation-- a Number of lines__.____------s?--------_-------Length of each line--- -.Width of trench__.____ ...-------------- Type ................. !sterial-- Depth of filter material-....--/ ,P.7-------Total length-------------- Type of filter rn� -- -------- Seepage Pit: Distance to nearest well-.---.----------------Distance from foundation--------------_---Distance to nearest lot line____--.-________ ❑ Number ine----------------- Number of pits---------------- ----Lining material-----------------------Size: Diameter---t--------- ---------.Depth--------------------------------- Cesspool: -----Dept k--------------------------------- \�" Cesspool: Distance from nearest well-----------------Distance from foundation- ------------------Lining material__.__.--__--___.____.____-_----______ --------gals, ....-------.Depth--------------------------------------------- -----_Liquid Capacity------------------- ------------------- ------- S'ze: Diameter Privy: Distance from nearest well- ------------------------------- ...... ---Distance nearest from n� Pg------------ _ buildin --------- ------------------ ------------------------------ ❑ Distance to nearest lot Iine-__.............- ------------------------ --------------------------------------------------------------- ------------------------ Remodeling and/or repairing (describej:------------------------------------- ---- ------------------------------------------------------------------------------ --------------- --------------------------------------------------------------I-------------11-------------------------I-------------I----------------------------------------I------------------------------------------------ I , ---------------------------------------------------------------------------------------------------------- --------------------------------------------7----------:----------------------------------------------------- --------- - --- - -- -- ------ ------------ -------------------------------- ------------ -------------: accordance with San Joaquin County I hereby ce f at-I have r pared this application and that the work will be done in at pared t1, have J"on I h 'y ce 4r dp g A ordinances. St a s, and rul d regalaltioh'i of the San Joaquin Local Health District, 1w ------------------------------------ (Owner and/or Contractor) .. .. .. .. .. (Signed);�14-- ---- -- ----- ----- --- ----------------(Title) ---------------------------------------------------------------- By:-------------- ------------------------------------------------ on of Sys em laced on reverse side). --------------------- (Plot plan. showing si of lot, loc ion of system in relation to wells, buildings, etc., can be p RX FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- 14-er—----------- ------------------------------------------- DATE A_ ---- REVIEWEDBY-------------------------------- - -- --------------------------- DATE------ -------------I--------- >�q__...-_____- BUILDINGPERMIT ISSUED------------------------------ ----------- ------------ ---------- --------------------_------------ DATE-------------------------------------------------- - - Alterations and/or recommendations------------------------ - ------ ---- -------------------------------------------------------------------•-•------------------•--•----------------------- -------------------- ------------------------- ----------------------------- ----------------------------- ------------------------------ - -------------I---------------------- --------------------- ------------------------------------- .... ...... ---------------------------------------- ------------ -- --------------------------------11------------------------------------------ Date....- ti------------ ------------------------------ FINAL INSPECTION BY:-------- -----------_----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycernoro Street 814 North "C" Street Stockton, California L*4i, California Manteca, California Tracy, California Es-9-2M 14S446 ATWODD 12-S4