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APPLICATION FOR SANITATION PERMIT Permit No. .-- --7- (Complete in Duplicate) Date Issued �VV4��- Applica*ion is hereby made to the San Joaquin Local Health District for a permit to constru and install the work her an described. This application �is made e�in.-c�o�mPli,a�n_cde " ith Co un+yOrdinance No. 549. �'�_ ------ �----- ---------� t,e---�---.- - -G�� ------ --•-'�-- JOB ADDRESS AND OCATION___ _ _ --�- y- --- -- ------ on Owner's Name_________ ------ -� r- - -- LL_ -- 0 1 -Address-----------------• , -----. Phone / — Contractor's Name---- ----- __ Installation will serve: esidence Apartment House'❑ Commercial ❑ Trailer Court Motel Other I! k 1 --- - ---------------------------------- jF: Number ofwliving units;- a ?�Numbe rof,bedsooms__ 2,LAumber•,,of baths rLof size___ _ .. .,, Water. Supply: Public system [I "Community system ❑ Private Depth to Water Tablet#• o Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa Clay ❑ Adobe ❑ Hardpan ❑ I New Construction: Ye� No ❑ Previous Application Made: Yes ❑ Noo - ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) p ,.��.yL' Septic Tank: Distance from', well__-�� Distance from foundat�on_�. �1----------Mat�r� I----------- -----------------•,�+ � _ _,Li 'd de th J - 3 - Capacity No. of compartments-----ar---_----. --Size-.�----- ---- - q • P f ' --- _pist&�ce to nearest lotsli Disposal Field: Distance from:!nearest well___ _�__ -._.Distance from faunda#ion__-_ _ __ . {{ ,yt ' Length of each line______ l.�dth of trench__- Number. of lines------- ------------- g ! Type of filter material_ _ ____-Depth of filter material_--__ __ ___ __.__._Total. length fr m fou ation___ - --_------Distance to nearest lot line__-- Seepage Pit: Dis#ance to nearest well___ � �/� +� Depth pits - g' rial-l,y�+c- .Size-'Diameter-- /-- --- -- P x Ces�ol: Distance from nearest well___________-----Distance w/from foundation___________________ Lining material_- __________ -- C`.umber of its___-__ .__.__-_-_ - Linm ma e _ P Li_uid 'Ca acit �j __ .gals Size:,Diame#er---- Depth q �4_P Y —F= Privy.-r- Distance irom-;:nearesf-well!'�_-'fi'"'"t � - �"'�" Distance from-nearesr building- -------------- to nearest lot-line----'- Distance .r:�.: -------- ^f 1 ❑ l` --------- Re delmg and/or repairing (describe:_-_ ¢ --•-----._ ---- -- -------- ---- 7� .: .rte--�° - r '� ' ---------- ' ...---- '`f` . I'h eb Leif at I Neve 'r - v �'------------------------ - Q y prepared t ' pplication and that the work will be done in accordance with San Joaquin County ordinances, State laws;iand rules'and re9ul +ions of the San Joaquin Local Health District. I I! " --------------------------------* wn tract _(O er and or Con or� ' By------------------- . r ��•�� --------------------------------------IT�t e la z-,------ - ;• --------- By_: (Plot plan, showing si e,of,lot, location of system in relation to wells, buildings, etc., can be pl@: reverse side].. H FOR DEPARTMENT USE ONLY r �, DATE-- �- --------- APPLICATION ACCEPTED BY_ ------- " -- REVIEWED BY------------------------- DATE ------------------------------------------------- -- r __ — ------------- r Alterations and/or recommendations_______________.___.__--_--- ---------•---------- ----------- ------------------------------------------------------ --------------------------------------------i0-•---------------------------------------------------- -•--- ----------------------- t -------------- - ti ------------- i ----------- Date -_f / FINAL INSPECTION BY;-7<----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT Oak Street 132 Sycamore Street 814 North "C" Street 300 West Oa r 130 South American Street Trac California Stockton, California i Lodi, California Manteca, California Y� .. ES-9-2M Revised W-2100