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+� APPLICATION FOR :SANITATION PERMIT Permit No. ..11k_a---'S (Complete lin Duplicate) Date Issued __---- sr Application is hereby made to the San Joaquin Local Health District ffo9r a permit to construct and install the work herein described. This application is made in compliance with County Ordsnanc JOB ADDRESS AKLn LOCATION. __ _ ------------------ ---- - --- - -------------- Phone------ --------------•------------- , - Owner's Name. C`A Address.------ -------- -----------•• -- ----------------- Phone .......... Contractor's Name__.�`�-""--V- `= Installation will serve: Residence A—Kpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / j--___ (Number of baths __.I.__- Lot size ____-j�__----,x Number of living units: _.(___-_ Number of bedrooms _l Water Supply. Public system 4-615system ❑ .Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No 4—New Construction: Yes [n No TYPE OF INSTALLATION AND SPECIFICATIONS: p No septic tank or cesspool permitted if public sewer is available within 200 feet.) � ce from f nc�ation---/0----- .Material Septic Tank- Distance from nearest wel .nC--Distan LJ Li uid de th_.. � Capacity__ 6- -----• No: of compartments_.-.2----------------Size_4� -. - -I----- q �` ii !yxrr�- Distance from foundation___/S---(.-...Distance to nearest lot line.-- Disposal Field: Distance from nearest wel I a___.- Number of lines-------/------- --------------Length of each line----� . -- -.--,-..-.Width of trench_ Type of filter material__--- -----------Deptl of filter material-----��--------Total length-------Z5---------------``------------ � rine rom fo ndation-.-�f 0-`--- istance to nearest lot line__.i_�_____. — Seepage Pit: Distance to nearest _---Depth Number of pits---- .Lining mate aL Size: Diameter-- _- p ------------------- _ s Cesspool: Distance from nearest well-----------------Distance from foundation----------------- -- Lining material____-______--._____.____------ als- -.De th --Liquid Capacity-------••---•-------- --•--9 ❑ Size: Diameter------- -------------- ------- -- ep --------------------- - -- --- --- r Privy: Distance from nearest well___-..___-__------ -----------------------Distance from nearest building.___..._---_.__-_______..______---------- Distance to nearest lot line--------------------------Is-------- -------- ------- Remodeling and/or repairing [describe)___________________________ -------- -----------------------•------------•------------•------- d _ a -- ------ ------------------------------------------------------- --------- ------ ------ f. ----- - - - --------- ---- - ------- I hereby certify that I have preparedduthis application the San Joaquin Local Health beDis nen accordance with San Joaquin County " ��.. ordinances*StateAa nd rules an gSi ned -------- ---------------------- ____-{Owner and/or Contractor) ------ ( g )..__ Title in relationt -------------( )------ -----------------•----------------------- -------------(Plot plan, f lot, location of systemo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE--------------- �.T'---------- APPLICATION ACCEPTED BY------------------------------- - S ff BUILDING PERMIT ISSUED----------------- -------------------- -----------------------------�----- ---- ----------------------------------- DATE--------------------------------------------------------- - REVIEWED BY------------------ ------------- ------ -----------�---------------- DATE----------------------------------------------------------- BUILDING and/or recommendations:._.___.._--------------------- ; --------- -------- ------ -----------------------------------------• -- 1 ----------------- --------------------•------------------------- •----- ------------- _- ------`�.----------• - ------ ---- - •----------------------------- --- -- --------------------- - - --------' ----- ---------------- r ---•-------------------------------- ----- lC FINAL INSPECTION BY------------- ------- � - - -•� I--•-�--- Date------- ---------- ------------•---------- ------------ •-----------------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. x Ei 145446 ATWOOO 1Z-54 -- - -- F