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\` APPLICATION FOR SANITATION PERMIT Permit No. ... 'Z"./.-5----. 1 (Complete in Duplicate) Date Issued Applica+ion is hereby 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 Ordinance Nq. 549. JOB ADDRESS AND L �ATION... +� f?_,. ?di�Jilw_a_l -------- ...._. n------------------------•-••---- ----- Phone.-- fp3 2 'jL Owner's Name-------------- Address-------------------------------- -- -- �' �' �' E''}� --------------------------------....._..--•---------------------------------------..---------I._.....--•---• Contractor's Name__.--------- +.._ _�t 5711 s `` Phone7P;t Installation will serve: Residences[ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ._�Number of baths __j___ Lot size ,z=____/.ca...............".__ Water Supply: Public system ❑ Community system ❑ Private ?- epth to Water Table i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑' Clay Loam ❑ Clay ❑ Adobe B--*Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ /J"L� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S Tank- Distance from nearest well------------------ from foundat+on--------------------Material"_"-_"_"..-"-_"_-_.______._______________"-_____. No, of compartments-- - - ------------------Size--------------------------------Liquid depth-----------------------Capacity-------------------•--- Di sal Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line________."-______ Number of iines------------- - - - ---------------Length of each line--------------------- : Width of trench----------------------------------- Type of filter material_________________________Depth of filter material ._..-_----------------Total length------------------------------------------ Seepage it: Distance to nearest well_1600-__-----Distanc _ rom foundation" -0__ line..--/ .-.o to nearest lot line..._ Q-- If Number of its___.__ Linin material.-. _ ____.Size. Diamefe Z S ........ ......." p � ---------- 9 �-�'--��--.....Depth----- ---- Cesspool: Distance from nearest well-----------------Distance from foundation----------..........Lining material-----.-------------------------------- F! Size: Diameter----------------------r--- ---------Depth---------------------------------------------------Liquid Capacity-------"-------------------gals. Privy: Distance from nearest well------_----------------------------.-------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line___________________________________ __ --------------------------------- ----------•-•------------------------------------------- ------------- " _ _ Remodelingand/or repairing (describe):------r------------------------------- --------------•---------------------------------------•----------------------------------- __-.-•---------------- - --- -- -------------------------- --------------------• --- -------------------------------------------•----------"----------------•------------------•--------••---------------------------- ..-.---------------------- I -------- -I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ` ordinances, State laws, and rules and regulations of the San Joaqui Local Health District. (Signed)-----------0. " --•--------------WYA-1001 '�-.--------------- ------- ----- ----------- fir Contractor) Septic Tank Service Title "" .__..... ---}2ftSU "€livor--iF ---F#ia �y { P ------------ (Plot plan, sho of lot, loc �asy .in re An to IIs, buildings, a ., can be placed on reverse side). FOR RT ENT USE ONLY APPLICATION ACCEPTED BY--- ------ DATE /---'r�_" REVIEWEDBY-------------------------------------------- •- ----- ----------------- --- -------------------------------------- -- ----- DATE-----------------------------------------.--_------------- BUILDINGPERMIT ISSUED--------------------------------------------------- -------- ---- - ----------- DATE------------------------------------------------------------•- Alterations and/or recommendations: ------ �'----•-------- ------ -1-----------------•-•---------------------------------------•-------------------- ------------------------ --------------- ------- �Y )� G---- --------------------------------"-------------------------•----- -------------•----•-------------- --� --------------------- -------------•---------------- -------------•--- -- ----------------- -- ,9 FINAL INSPECTION BY..--- � 5 ---_--��.=�... .----------------------- Date_. ---------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Horth "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOO❑ 12-54