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APPLICATION FOR SANITATION PERMIT Permit No. .--��,�-.-�------ Complete in Duplicate) Date Issued Applica+ion is hereby made to'fhe San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 6 > � L ------•-----e ------------�------------------- - JOB ADDRESS CATION-----� ---- �-- --------- ------------- ---------------- ------ Phon-- � Owner's Name---- --------- 0-S-'� . ... Address = - / -•---------------------- --------------------------•------------------------------------------------------•------------------------ Contractor's Name----------- _ f --------- -----------=---------=-------------------------- one__.Oth--...��..' Ph Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ter _ __________--------._______.________ A . Number of living units: -------- Number of bedrooms -------- Number of baths ______:_ Lat size ____ ---------.."- Water Supply: Public system'❑ Community system-.❑ Private�epth to Water TableJ^ ff. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application'Made: Yes ❑-IN, �ew Construction: Yes ❑ No ❑ C � TYPE OF INSTALLATION AND SPECIFICATIONS: _ No septic tank'or cesspool permitted if public'sewer is available within 200 feet.) . - . . E is T Distance from nearest well-----------------Distance from foundation_____-_____________.Material__."____t_.___._------------------"------------ acitY Liquid de th------------------------`Ca o: of.compartments- ----------------Size---------------------- q P P Di osal _e' Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line._______._______. Number oTdines------------- - ----Length of each line -----Width of french------ ------------------:------•-- Type`of.filter material.____ Depth of filter material___.______________."-Total length_____________________- --- _.�w _.._ ---`-------- Seep^ag�e P't' Distance to nearest well--19.b______-.__Dis#ante fr foundation__ ________..._..Di tante to nearest lot line �? LJd� 2°L- Size: Diameter �- Depth Number of pits.___.___"___.___--_-Lining material _ _.._____._ - Cesspool: Distance from nearest well-----------------Distance from foundation---------------"___.Lining materia4___.______ ___.____________"_-_____. ,Size: Diameter__.; "--- ---- - - -Depth------------------- -------------------- .Liquid Capacity----- •---4--------�:-- -El _ _ gals Privy: Distance from nearest welL..._____.___"______________ -------------Distance from nearest building,----------------------------------------- I ------ ------ ------ - ----- ------a ..� - ---- ---------------------- ❑ Distance to nearest lot line -----------° ----------------------------------" re -•---•--•---• ' '� ----- ------- ------- -- -- ----- __------ Remodeling and/or repairing (describe)________________. '�--- i- 1 ------•--------------------------------- ��----------- -------------------- •••--- t -----------------------------------------------•-------------- ............. ` ------------------ - -- -�------------------------------- ty I hereby cerfi y hat I have pr ared this application and that the work will be done in accordance with San Joaquin County .Lordinances, Sta la s, and rules an regulations of the n Joaquin Local Health District.` " - ggrrm—&ndfsr Contractor) (Signed ---- --------y--- --------- - --- ---- - [Plt plan, showing size of lot, location of s stem in ation to wells, ildin o p g - - gs, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY , p S APPLICATION ACCEPTED BY----- ------ - ------------------------------------------------------- DATE------ - 13 —5 .. REVIEWEDBY---------------------- -----------•-------------•-- DATE------------------------------•----------------- --------- BUILDING PERMIT ISSUED---------------------------- ----- : ' DATE--------------------- --------------•�---------------•--•---- Alterations and/or recommendations:------- ------------ --------- -- ------------------------------i---------------- ----=--•-----........ ------------------ :. ------------------.---------------------_ - -----•---- •---... ,... -------------- --•-- -----•----------- --"---- -- •--------------- --•---;----•---•----------- --- ------------------------------------------------ FINAL INSPECTION $Y:.__ - Date_-------- '= f -------------------------•--- ��' ----- •-------- -------- ''_''""_"`'--------------- -- SAN'JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak'Sfreet 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y E5- 9 2M Revised.-,W.-2100