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- APPLICATION. FOR SANITATION PERMIT � Permit No. �- { (Complete in Duplicate) U' Date Issued ---- _-/-----_----�_-- Application is hereby made to the San Joaquin Local Health District fora permit t construct 17eb_[60 This a lication_is made in..compliance with County Ordinance No. 549. p st ucf and install the work herein described. ADDRESS A OCATION__.___ _ _•_464- __ ]'�l?ji----------- i----- `-- S v�� �' � `'-�`--"-- ' Owner's Name_ _____ Phone- Address------ hone_Address------ - - _7 r-:---- - -- - ------ -----•----------------------- � Contractor's Name -------------------------- PhonL(F_ ,t_ C� Installation will se e: Residence Apartment'House ❑ Commercial ❑ Trailer Court ate}-0 0t#ae Number of living units: _/_. Number of bedrooms___ Number of bafhs� _I(--Lot size _-_ Q___ �✓le�r ---_fes Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table Character of soil to a depth of 3 feet: S�// Gravel ❑ Sandy Lo;PN5, -ClayLoam Clay r ❑ y ❑ Adobe❑ Hardpan � Previous Application Made: Yes ❑ No New Construction: Yes ❑Ta FHWA, Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' S (No septic tank or'cesspool permitted if public sewer is available within 200 feet]`" "" a4 Septic T Distance from nearest weI4M -__Distance from foundation__-_____ __ � ��xr), rial No. of compartments-_- e� �'` - - Si %; - ;f&cla Liquid deprr _Ca act Y�- f �� - -------.-- p t - COQ--------Disposal Id: Distance from nearest weli-f9-C---_Distance�rofiTfoundation/r© 000 _-____. nce to nearest lot line___ Number of lines----- ---- ---- -- f ``�, -_ , Length of each line_Jr lr---' Totdthl of r nch 5"-- Type of filter material_�l�--_ Depth of"filter material___/S_e , g ' Seepage Pit: Distance to nearest well------- -rZ ____Distance from foundation-----__-------------Distance to nearest lot line_______._____: �� ❑ Number of pits----------------------Lining matera_----------------------Size: Diameter-------------- - material ------Depth:----------- --------------�-- `� Cesspool: Distance from nearest well------- Distance from foundatiIon______ -----Lining material___--_____-_ ___---__._-_____-__:_ ------------1 11 I f ❑ Size: Diameter Depth - - 1 I t Liquid Capacity ---------------------g Privy: Distance from nearest well____________________________ ___________-__--- Distance from nearest building__________________ ---- El i0 . Distance to nearest lot line____ ; ---------------------------------------------------------------I - Remodeling and/or repairing (describe)______________t_� ---------------- --------- .` ' -------------------------------------- # ? -t ------------• -- - ----------------------------------------------•--- Y y pre aced this application and that the work w ----------------------------- ------------------•-----------------------------------=& ---------------------------------------------------------------------------- ere certify that ! have p pp' illi be done in accordance with San Joaquin County ordinances, State laws, and rules and -�regulations of the San Joaquin Local Health District. (Signed) Li `�l'��-T__pp � 411k Zi/,_U`�.-------------- (� Contractor) Plot Ian, showing size of lot, location of system in (Title) ------------------------------- I P 9 re Jo wells, buil gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE_ �� `-r -----------------------------=IEWED BY----------------------------------------M.__---------------------- ------------------- - DATE- ------------------------- BUILDINGPERMIT ISSUED---------------- "-------- ---------------------------- DATE -------------------------- Alterations and/or recommendations------------------_ --------------------------------------------------------------------------------- '.' --------------------------------- ------------------ ----- r FINAL INSPECTION BY:.--"-4 ---- -- ---- Date rI�_e� 0 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sou4h American Street 300 West Oak Street 132 Sycamore Street Y 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Y//ES-9-2M , Revised 1.57 F.P.CO.