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s APPLICATION FOR SANITATION PERMIT Permit No. �._�... (Complete in Duplicate) // t��'�• y Date, Issued District for a permit to construct and install the work herein described. Applica§ion is hereby made to the San Joaquin Local Health This application is mad]e`in compliance with County Ordinance No. 549. JOB - A ADDRESS AND TION -_- -_--_ // f�-C.��-------- �---------- -------• --------------------------- ------•--<.---•_--------hon---,r�'�-��------_----- Owneis Nam = - #------•------------------------- ----------- --------------------------------------- - -. -• ------ -----. , ] e. _ ... ----- ----------------------------------. �. --------- Address Contractor's Name------------- re - one 3 �- �u f --- Ph--,�� f-- - -- -----f ---- , .. . T Installation will serve: ' Residences Apartment' House ❑ Commercial ❑ Trailer Court LlMotel E] Other [3 s Q4 4x7 ' !Number of living units: __./--- Number,of bedrooms _%____ Number of baths -_- Lot�size _____ ___-_,___----------------------- Water, Supply: Public system Com unit system ❑ Private ❑ Depth to Water T.abl - ft LL Character of soil to a c th o" f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob Hardpan ❑ P ( I Previous Application Made: Yes ❑ , NOK New Construction : Yex No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank ar cesspool permitted if public sewer is available within 200 feet.)�:,, \.7� . .- .T...._ Y Septic Tank: Distance from nearest .well i Distance from fo nd)tion__ r Material �.—-- ,Sizes_ /_ Liquid de th__._.--- __.Ca acit No. of compartments__---- q E? P Y `' F / ` • 1 * i • Disposal Field: Distance from nearest well___-.__.'.___ Distance from foundation_.__________. ___._fDistance .to nearest lot line _._.__:________. Length of each line---------------------------- -Width of tren'ch ---------------------_-- of lines--------------�_�°--�------------ -------- ' -•._' `:-' Depth of filter material__._ .____ __ . '____Total length' ------------- - --------- _pe of filter materia3 ,___ _ R p... .;.,... Distance to nearest lot line Seepage it: Distance to nearest well-- --------- --- Distance from foundation ---__-_ _____ _---. Number of pits --1#----------- ----Lining material-------------- --- -----Size: Diameter----------------------- Depth------------------------ ---- ❑.materia-l---. i Cess o01: Dista nce`from nearest well -------------- _Distance from foundation___-_.___.___`__- Lining material-_-.---------------------------------- cesspool: _-_----__.._---_-___--_-_______ p _ Li uid Capacity _ ' _ cls. EliSize: Diameter. � l ----1---- ------=------- .Depth-------------------`--------------------------------- ,- 4 p ---- -.-------------•-- - ` Distancefromnearest buildin ' ` Privy: Distance rom nearest well--=----------------- ----------- _..w. 9 :: : �.. s Distance to nearest lot line_-_._..._._ -- -- ---- ❑------------------ =- ----------- - -• -------- #t r F f Remodeling a /or repairing (describe):_ ----------- ' -- -- - r ----------------- - --- ---------------- --------�� = F -- ---_ _ _______________________ _ -- --------------------------- I hereby certify that I have Prepared this application and that the work will be don` in accordance with'San Joaquin'County ordinances, Staf s,{and. s nd reguw! s f the,San Joaquin Local Health District. 1 (Signed)-------- -- ----- 3 - P--- -------- ----- �------ ---------------------------------------------------------------{ r caner and�br_ntractor) --------------- L ------------------ $ n relation fa walls buildings, etc., (Title]_____-_-_ _ _ 7-------------- ------------- I �Y� t (Plot plan, showing size�of lot, ocafion of system i,can be p a on reverse sfde). c FOR DEPARTMENT USE ONLY ( _ i : 3 APPLICATIONACCEPTED BY---- -------- a --------------------------------------- -------------------------- DATE:-------------------------------------- ---------------------- --------------------- ---•- REVIEWED BY--------------------------------------------------- = I `----------------------- DATE---•------- ---------_-•-------- - F c 1 BUILDING PERMIT ISSUED---------------•--------------- DATE: -----•----------------L - = ------ ' .:.-------------------------------- � A Alterations and/or recommendations:' - - - ----- ............................................. -- ----------•-------..................----- ----------- F A. [ I l Y -------------- -______ __ _- _____. _______________________________--- ________________________ F i r -- ---------•-- ------ # - ------ --- --------------- ------------------------------- - -- c ' I � - k i 1 --------- FINAL-INSPECTION BY:_.` ----------- ----- Date ----- --------------------------------- 4 SAN ----------- --------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES -9-2M ' Revised W-2100 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Lodi, California Manteca, California Tracy, California