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�APPLCATION FOR SANITATION PERMIT 4erm"iNo. /. � {Complete in Duplicate} Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and instal This application is made in compliance with County rdinance N . 54 e work herein described. JOB ADDRESS AND L TIO A' - - -- - Owner's Name----- ------------------------------- Address ��----------------- Address --------------- ------ Phone- ,4�-`------ -=-•-- r . �� ------- Contractor's Name - a - ---�`.f>�.�1.��-__--� """ -- ------------------------=------------------------------ Phone i- Installation will serve: Resi ence ❑ Apartment House Commercial ❑—]Jailer Court ❑ Motel ❑ Other Number of living units: ❑ -- Number of bedrooms __ Number of baths -- Lot size __ ,-- C'" Water Supply: Publics stem Community system ---- i'P Y� y s Y Y ❑ Private ❑ Depth to Water TableQ" ft• ! Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay Previous Application Made: Yes El No X New Construction: Yes 9 N ❑ ❑ Adobe � Hardpan El TYPE OF INSTALLATION AND SPECIFICATIONS: ~ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { 1)4 Septic^Tank: Distance from nearest ell" Q(y, Dista c_e from oundation:___ f--____Ma real--- y'4�( No. of tom artments-- j � " i" " p h-----------------Sizers- -= 9 ii a iquid depth_-_ Ca acit }•q ' �r r p Disgil Field: Distance from nearest welL,[F M4 Distance from foundatic - - �� Distance to nearest of line_ Number of•lines-_ _ -----"" F-Len Length of each line" _ ----------- _ "T1- g �- T -r/-___-.Width of french- Type Type of filter material ._j Depth of filter material- :---Ifp -.--_ __Total length----•--- Seceage Pit:. - Distance to nearest we I_- / __ Distance m fo dation_- "` Number of pits;__64 D f ncye to nearest to p -w--Lining material__ ,. _�5ize: Diameter Depth- ----------------: esspoo: Distance from nearest well_______________ Distance from foundation__---------__---_Lining material----__.-_-_-_--- _ ------------------ � ❑ Size: Diameter---------------------------------------Depth---•------------------------- - -----------------Li Liquid Capacity Priv f 9 p tY ------------------------gals. Y Distance from nearest well--------------_-- _-------__ -___ Distance from nearest building--'---- El Distance to nearest lot line_-__--__ ------------I---•-- Cr--, ------------- ---------•---- --•- Remodeling and/or repairing (describe]; --_- - _ ---- ----- ----- - - - - - -- - - ----- , ----------------------------------------------------------- -- =------- ---- - --_;> ---------- •--•------------------ _ - --------- ----- - --- ------ - -- -- cer I hereby s'an rules and reat I ave prepared this appR ordinances. Stateate l ation and that the work will be done in accordance with San oaquin Coun laws gulations the San Joaquin Local Health District. � (Signed)_-----•----------f -- � r (Owner.ar1'd/off ontractor] BY: - � � r red �i �Jf �1 (Title}- 7 u :� - .�-} (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_--"'--- REVIEWEDBY------------------------------------------------------ -------- - - DATE---- = el/----- -------------------------------------------- - BUILDING PERMIT fSSUED -------------------------------- DATE ---------- - ------------- ----------- DATE Alterations and/or recommendations:_-.- --_-- --------------------- - ------------------------------------------- - ------------- -------------- __ --------------------- -------- - ----- __ 5s 27 �� "" -------- -- - ----- - --- -- - FINAL INSPECTION BY --___-- .. Dater SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ' 300 West Oak Street v 132Syeami,� Stockton, California= re S+ree+ 814 North "C" S+reef ' lodi, California - Manteca, California Tracy, CaliFornia E5-9-2M 8-51 Revised W-2104 t�