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A_._sLICATI N FOR SANITATION PERMIT Permit No. .. _Z7'�__ (Complete in Duplicate) Date Issued _--� - �L y � Applical-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 Ctgunty Ordinance No. 549du JOB ADDRESS AND LOCATIO -. -- > - `- -.-- ^„ . ----------------------------- Owner's Name------ -------- ---) I - �- --------------- '- -- . Phone. Address --�----- ---- -------------•----------------------•------------------------------------.------------------ --------------------------------------------- Contractor's Name ;F 1- --- ----------•--------- --------------------------------- ---•- -------- --- ----- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [-]'jMotel ❑ Other ❑ t Number of living units: -- ---- umber of bedrooms_._;Number of baths _1..... Lot size ._ ---- -- C_/ � " Water Supply: Public system Community system [❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam E] Clay ElAdobe Hardpan E]Previous Application Made: Yes El No New Construction: Yes [/No EJ TYPE OF INSTALLATION AND SPECIFICATIONS: .� .�.. r [No septic tank or cesspool-permitted ifs ublic sewer is available within 200 feet. Septic 'ank: Distance from nearest well_/.;4* /T Dista from f nda,Jt' n_:-/. ............-Ma e�ial__-.,°- - - _ Er No, of compartments __- - .. X,a - "l p iii= _. Size_ Liquid depth_-_ --------- Ca aat yl:= r +* ►r, t r.a r r P Y----�' "l S f Dispos Field: Distance from nearest we _._ _��Disfance from found tion_. __ _.___ Distance to nearest lot li efF.___--.+---____- Number of lines---------- _- """ � �� -- .Length of ech lineZ �_ .Width of trench------#1+- ---------------•- Type of filter materi _- ----- ----- of filth r material__-_._&_ _ Total len th___.___ Seepage Pit: Distance to nearest well_--------------------Distance from foundation___-1--------------Distance to nearest lot line------------- ❑ - Number of pits------------------- --Lining material-----------------------Size: Didimeter-----_------------- ---Depth a ------------------------------- Cesspool: Distance from nearest we}I-----------------Distance from foundation_...:._____.........Linin l_ materia .--___-..._____--..__ ❑ Size: Diameter Depth -•------------------� --------Liquid Capacity- --------------- ---------gals, l Privy: Distance from nearest well------_---_-------------------- i__.____Distance from nearest building _ ---- ❑ Distance to nearest lot lire---------_______ ...... S ----------------- - -•-------'------ -------------------------:---- -- ---------------------------------------- I lie odeJiKg and/or repairing (de -rrbe):___ -----------------------------------••-------------------------•----- -- --- --------------------------------- -------------------- --------------------•-------------- --------------------------------------------- ----- .--•----------- --------•-------- ------------------------------- ----- -------------------------- ------------- - _------- s I 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 ruled regulations of the San Joaquin Local Health District. : " (Signed)_- __________________-(Owner and/or Contractor) r By: -------- -•-------------------------------------------(Title)----------- --------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B -------------- ----- ---------- ---------------------------------------- DATE— ~' REVIEWEDBY --------------------------------- -- --------------------------`------------ - --------------------------------- DATE _.. 10% BUILDING PERMIT fSSUED ---------------------------------------------- ----------------------------------------------- DATE.----- •__.. _ ._-__. .�. .........` Alt - tn --- -------- ------------- ------------------------- - •-------- ---------- -----------/ r FINAL INSPECTION BY:_... __----<_ L__�'� D --�SAN JOAQUIN LOCAL HEALTH DI - i30 South American Street 300 West Oak Street 132 5 camore $fres! Y 814 North "C" S+ree Stockton, California Lodi, California Manteca, California Tracy, California 5-9 xgsgqfi ATW DDD l