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f� APPLICATION FOR SANITATION PERMIT Permit No. a v-- 1 (Complete in Duplicate) Date Issued Application is hertl made to the San Joaquin Local Health D.istr.ict,for.a permit to construcf,and install"the work herein described. This application is made incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-.__-- - y -------------- Owner-':s Name-----------•- h P --Zs Address-•-------------- - ...4,;� ------- •-� • ------------------Name----=�..----••---------•--------•-----•----- --•--•- ---------------T4}------------------------ --------------------------------------------- Phone Installation will serve: Residence T Apartment House ❑ti Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms .. Number of baths __/ -- � � Lot size —--------------------- stem •�.- -------------------------- h Water Supply: Public system ❑ Community system ❑ Private'[- Depth to Lfer Table _'- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Q AndyLo - C�yLoam-❑. f' lay ❑ Adobe 2q--hiWrdpan ❑ Previous Application Made: Yes ❑ No New Construct+io: Yes Flo ❑ ,. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if//pubiic'sewer is available within 200 feet.] Septic Tank: Distance from nearest well__14��____Distance from fo ndafion_- I ' 1 Materia! 1�tYgr-�C s _do. of compartments....L ---------- Sie -- Li---Liquid de thJ _..-- Capacity-----'-- Disposal Field: Distance from nearest We114�_:- _Distance from foundation_P--.P.. o - Distance to nearest lot line_- ---_--_.--'"V Number of lines---- f--- ----------- -- Len th of each fine---- / 7 r r " g - Width of trench---- Type of filter material_- ------Depth of filter material-_ '"_!_ ---------Total length.-_ _+. ------------ --------- Seeps a Pifi: Disfar e to nearest well---1U __�------Distance from foundation----- n Distance to nearest lot line- -.- �-- Nurn-er�of pi s�-.-__-_- -____ --Lining material --------I� LCSG -Size: Diameter-- -_- - -- !! Depth--- ------------------ C 1: Distance fizom nearest well-----------------Distance from foundation.-❑ _ _ ---- --_----.Lining material Diameter ' _ -.---_----._- ---- + ---------------- Depth -------------------•--------------- - ---"------Liquid Capacity-.--------- •---------------gals.Privy: Nsfance from nearest well------- ---- 1--------------------------_----Distance from nearest building ❑ , Distance to nearest lot line..___-.-.__--------------------- Remodeling and/or repairing (describe):-___ __________ -------------- ------ ----------------------------•-----------•--------------------••------------------------------------------------------------------------------------------•------------------------ "--------- A hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, (Signed).. �' '--��- �--------------------- ------ ----- ---------(Owner and/or Contractor) ' - --- -- ---- ------------------•-- --------------------------------------------------------------- ---- --- Tale ------------ ---------------- ____ 9 P ------------------- (Plot p an, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- -- ----------- ------"-------------------- DATE----REVIEWED BY - 'r ------------------- -----:------------------------------------ -- ------------ DATEBUILDING PERMIT ISSUED------------- - *E_ - --------------------------------------------------------- DATE--- --------------------- Alterations and/or recommendations-------------------------- ---------------------•----••--------------- ---------------------------------- -------------------------------------------------------------- FINAL INSPECTION BY----- -------- ------- -----r---.-_------ -- '� `� 1 Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130'South American Street 300 West Oak Street 132 Sycamore Street y 814 North "C" 5tra@t Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100