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APPLICATION FOR SANITATION PERMIT Permit No. ___7 V_17..._.- (Complete in Duplicate) Date issued -_____��-� Appiica+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 No. 549. JOB ADDRESS AND L Owner's Name--Cr- -- ---------- --------- -• --�--------,------- - ----- Phone.------------------------------•--•- 07 ----------- ---- ------------ --... ----------------------- ------------- ------------------ --•----------------------- Address Contractor's Name -----------------------------------------•---- ------------------------- __ P ...... - -• -- ----------- Installation will serve: Residence ,® Apartment House [-] Commercial E3Trail o,e e ❑ Other E]Number of living units: __ __. Number of bedrooms _i� umber of baths -_. __ f sslzee`�- _ -______ ----___-_.__---- r Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table A�_ ft. Character of soil to a depth of 3 feet: Sand ❑. Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No X - New Construction: Yes A No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ��.. moi. b.,vn Septic Tank: Distance from nearest well __ __.__Distanc fro ounda Mat riaL-- -- ------ ----------------- ---------------- ` '�-� No, of compartments-------- -��'1�__Liquid depth_________ ___ __________ Disposal Field: Distance from nearest well.-.__5o-0-Distance from foundatio __.__..._ _ Distance to nearest lot li e---- Number of lines------ --_---�____.._____ Length of each line___ _. ___��_..._.Width of trench --- Type or filter material_ _!. ._....___ _ Depth of filter material____ �_ __.___)_ ___Total len th ___ �( _ Seepage Pit: Distance to nearest well______________--------Qistance from foundation. d'(•rJ'ty . a ce o n es rfie--,---__�-______ C ❑ Number of pits----------------------Lining material---------------------.-Size: Diameter-----------------------Deptn_ --- ----_.+ r'---- !� Cesspool: Distance from nearest well------_-___b'__Distance from foundation--------------------Lining material____Ay- _ ---- ❑ Size: Diameter----------------- ------- ------- Depth-----------------------------------------------. . -..Liquid Capacity �� J gals.. k . t - _ , p ty---- ------ '; - 9 Privy: Distance from nearest well----------:----'-------------------- -------- --Distance from nearest building------- ------------------------------- Distance ---------- ------------------.Distance to nearest-lot line- ------- ------------------•----- = emodeling and./or r pairing escribe) --- Y !3 iia-! p1 = .. .. � ----------- hereby cerci .y that I have prepared +his app€icwsi.n and that the work will be done,in accordance with San Joaquin County ordinances, Sta+ aws, and rules prid regulations of the San Joaquin Local Health District. (Signed]_ ------'-----------------------(Owner and/or Contractor) --------------------------- Title - By: ) (Plot plan, showing°siie of lot, location of system in relation-to'1 ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------__----------------------------------------------------- DATE------------------ REVIEWEDBY---------------------------------------------------------------- DATE-------------- BUILDING PERMIT ISSUED---------------------------------- ----- DATE-------------------- Alterations / �r ----------------- Alterations and/or recommendations:----------------------------- ------- - -------- -----------------------------------------. ---------- ------ ----------------------------------------------- __ __ -' - -------------•___....__.---.----------'--•----------------- ------ FINAL INSPECTIO BY:------ f ] Date--- SAN ate.SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 aTwooa 12-54 .