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a APPLICATION FOR SANITATION PERMIT Permit No-;_ ►_ __� ,�� ✓` (Complete in Duplicate) ------ Date s all the work herein described, [N � Application is hereby made to the San Joaquin Local Health District for a permit to construct and in + This application is made in compliance with County Or inance No. 549. i - JOB ADDRESS AND LOCATION___ Owner's Name -- - -- ---- Address .................................. Phone--- ,--� --. � � Contractor's Name________________________ g ± 1� ' Installation will serve: Residence ----------------- Phone-_�_- !�f3 Apartment House --------- Number of Iivin units: ❑ Commercial ❑ Trailer Court ❑ Motel g /____ Number of bedrooms __-__-_ ❑ Other 40 Number of baths __f_ Lot size _-:� , ��------------------ c Water Supply: Publis stem _ Y ❑ Communit system Private Depth to Water Table Character of soil to a depth of 3 feet: Sandy y ❑ � P ft. Previous Application Made. Yes Gravel ❑ Sandy Loam ❑ Clay Loam ,,�� Y ❑ Gay ❑ golobe� Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:ew Construction: Yes No ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel _ � I 49--__-Distance, from and a xr No. of compartments_ S1z ` u �: M terialje ' _ ° } ----------- ---------------- p Disposal Fiefd: Distance from nearest yell: Q_� Liquid de +h__ _�` _ _Capacity__ �•IP l Distance from foundatioq,�� _ Distance to nearest lot line__Ce Number of lines__________ _____ __ __ --Length of each line-____---- Type of filter ma#erial_' ]- ----- ----Width of trench-_a. �� �!i----Depth of filter material___- ----------- Seepage Pit: Distance f nearest well--d-_Ql�_ Distanc fro fou dation__ Q-!._.pistancentgo nearest lot line__ -"_ • -- 1, Number of pits------I______________Lining materia A s f UW--- Diameter_,J ` - Cesspool: __ -_-_-__-.Dep#h___ _ _ ❑P Distance from nearest well------------------Distance from foundation---------------_____Lining material ___--_____ Size: Diameter_________________ __ Depth_ --------------------------------------------Liquid Capacity Privy: Distance from nearest welly_____._-______________________ -�------`------ ` ❑ Distance to nearest lo+ line_____--_ '_.___-__ Distance from nearest building_________________________ ---------------------- --------------------------------------- Remodeling __emodeling and/or repairing (describe:.__-________ # ------------------- ----------- - -•------------------------ •------------------------•--------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co_nfy,�- , ordinances, State laws, and r les and regulations o he San Joaquin Local Health District. (Signed)__-- --- -----�---------------� -- :9 ------- -. ----------------- Contractor) (Plot pl - - -------------------------------- ----- ----- - ----- - - win size of to}, location of stem in relation to wells, buildings, etc., can be placed on s �9� ---------------------------- side). - ------, -- - --------------- rever FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ REVIEWED BY------------------- ------- DATE__'4' ------------------------------------------ BUILDING _ _ - ---------------------- ---------------------- UILDING PERMIT ISSUED------------------ DATE-------- ,/ A terations and/or recommendations--------- ----- --- ------ DATE------------------"�--------------------- ------------------------------ ---------------------- - - ------------------------------------------------------------ -- -- ----------------------------------------- - - ---- ------•------------ FINAL INSPECTION BY:-:---------------_______ __ �� SAN JOAQUIN LOCAL HEALTH DISTRICT f30 South American Street 300 West Oak Street Stockton, California Lod132 sycamore Street 814 North "C" Street i, California Menfece, California Tracy, California t ES-9-2M 8-51 Revised W-2100