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a APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) ( � Date Issued Applica{ion is hereb 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 Ordina e No. 549. JOB ADDRESS AND LOCATION______: d-____, 9 _____________-__ ----------------------------------- Owner's Name------------------------------- ----- ---- --- �.. Phone,. r �a d_r� Address-----------------------------------------....... ---- l. r.,r/t _ Contractor's Name-.- --•---------------•----- E/lla-& ---------------------------------------------------•---------- Phone---------------------- i Installation will serve: Residence Apartment House M Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __k Number of bedrooms _._._._. Number of baths _I-_- Lot size -_ ,J_� ___.L ------------------- Wafer Water Supply: Public system E] Community system El Private' Depth to Water Table (1ft. Character of soil to a depth'of 3 feet: Sand ❑ Gravel.❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe4 Hardpan ❑ Previous Application Made: Yes ❑ No ❑ 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 nk� Distance from nearest well---------.---r-.Distance from foundation__ _------.Material------------------------------------------------- No. ------------------------------------ -----.No. of compartments-----------``--------------Size--------------------------------Liquid depth-- -----------------------Capacity------- ------ pos Vield: Distance from earest well-60---------Distance from foundation----�_r_____Distance to nearest lotlii`e---- ,J Number of lines___.___. _ _--Length of each line--- �___�__r__ ______Width of trench_o2�-.---.---.-.---__.----._-- Type of filtePmaterial-__---- i �._-Depth of filter material_---. _`---__Total length_.c_0------------------------------ Seepage Pit: Distance to nearest well_ Q-_-----------Distance fr m f��undation__4 ____..Distaance to nearest lot line-.--s -_ Number of pits___.---------------Lining material_j--__.Size: Diameter-_3 ��_---.-------.Depth_-_aa---.______# Cesspool• Distance from nearest well_-_-------------Distance from foundation--------------------Lining material.----._--------_---.-_--_____------- ❑ Size•: Diameter----- --------------------------------Depth------------------------------------"-------------Liquid Capacity----------------------------gals. Privy: Distance from nearest weN--------------------------------------------------Distance from nearest building-------.---_--.-_----____-_--____-_._.-. ❑ Distance to nearest lot line-- ------°----- -- ---------------------------------••--------------------------------------------------------- ------------ Remodelingand/'or repairing (describe):-------------------------------------------------•--------------------------------------------- -------•---•-------------------•-•--•----------•-------- ------------------------------•-------•----------------••-•----•--•-------•-••---------------------------------------------------------------------------------------------------------------------------------------------.-----------••-----------------___------------------------------------------------------_._-----------------------•--'------------- I herebykaf ify that I have epjis application and that the work will be done in accordance with San Joaquin County ordinances, Slaws, a ul ndtions o the San Joaquin Local Health District.1(Signed}-------- -------- - ------ -----4well �------------- -------------------- e' Contractor) Sy:-••-------------------------------------------------------------- --- -------- --------------------------(Title)- f --------------- `- (Plot plan, showing size of lot, location of syste m relation ldings, etc., can be placed on reverseside) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATEf v� f ------------ REVIEWEDBY--------------------------------------------------------------------------------------- --------------- -----•- -------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------`------------------------------------------------------------------- DATE Alterations and/or recommendations:------------------------------------------------------------------------------------------------------•----•-------------------------------------------------- ---------------------------------•------------•------------•-----------------------------------------------------------------------------------------•----------------------------- --------------------- ------•-•------- ---------------------------------------------------------------------- ------ - --------------------------------------------- ------------------------------------------------------------ ----------- ------••-- - FINAL• INSPECTION -BY:--------------------•--_- Date----------------------------� .. _ /•2 — Z -------------------------- _j- --•- . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M Revised W-2100