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APPLICATION FOR SANITATION PERMIT �1 Permit No.�.----- 7---•--�--.. (Complete in Duplicate) Date Issued --- - - n Jo n Local Health'Distric`t for a permit to construct and install the work herein described. ' Application is hereby made to the Sa q This application is made in compliance'with County Ordinance No. 549. JOB ADDRESS AND -------------- LOCATION"" 1 phone ' �-" "ni l�--------------------- - t �- 4, Owner's Name---- �-5�x-�/;v-. = F � >� f ,'=---- ---- -------- i Address-----------•------•---- - - -- -� i --- Phone" ----�-o- ( _-��---------------- . ° size "-: Contractor's Name-----•-------• Other ❑ Installation will serve: Residence ( Apartment House ❑ Commercial ❑ Trailer YCourt Mote ❑' ©x... - ba Number of living units: _ ----- Number of bedrooms -` Nu D thhta Wat Table " Zft. Water Supply: Public system Community system ❑ Private ❑ p i( e Gravel Sandy Loam��""C aY'L�Ddn' ❑ Clay [] Adobe Hardpan ❑� Character of soil to a depth of 3 feet: Sand ❑ ❑ New Construction: Yes ❑ No x Previous Application Made: Yes ❑ .i A TYPE OF INSTALLATION AND SPECIFICATIONS: ailable within 200 (No septic tank or cesspool permitted if public sewer is avfeeti.' #1;._t ..Ma erial------------------------------•----------- y� r ______ �" ---Capacity ' eptic Tank; Distance from nearest well-----------------Distance from foundation Lkepth_-.._.� - ---------------"" „ �1 No. of compartments------.--- Size---------------- !!q�� D�sfance to nearest lot line_-------•-------• V field: Distance from nearest well” _ Distance from foundation:"--- -- posal e3 ..---- ----Width of trench------------- ` ----__-Length of each lin �-- Number'of lines-_-A------------------ T g �?' d ( Total length Type of filter material-------------------------Depth of filter matenal_� c- ,-------� ±� --• Distance to nearest I t fine"" --- " De t'n Seepage Pit: Distance to nearestwell"-_/\!C2ltf DistanceLr,om foundation___ i. INumber of pits._Q- C-------Lining material---- 'u�- --Sze: Dia eter"-- " p ihg 1K 1 Cesspool: Distance from nearest well---------------- Det+hce from foundation__- --- �iaC pacity- gals' ❑ Size: Diameter l p i !" . Distance from nearest.building-"--._ ."- "--"- -"--"-."_".-"- .- --. Distance from nearst well-----------------------------------�------- "-- - Privy; ❑ Distance to nearest lot line-------------- --- ---------------- -- --.----- ------ L w ---- _ _ f ---- ',�-------- Remodeling and/or repairing (describe):--- ----- f --- ----------------------------------- --------------------------------------------------- ------------------------ ---------- --------------------- -------------- �-"-d�}hat—thew k"wilil one lin acc rdance with San Joaquin County Y r I hereby certify tha , a preps ed this application ordinances, State laws, nd r es and regula .. is of a San Joaquin Local Health District. ___Fdo� -----(Owner a /or Contractor) �� Q ---- a Si ned Z [Title)------ -- - BY•' =Plot Ian, showing size of lot, location of system in relation to ells, buildings, etc., can be plat reverse side]. FOR DEPARTMENT USE ONLY DAT EAT 3--------------- �_ .,.� APPLICATION ACCEPTED BY- :e - r BATE -- REVIEWED SY_ ,• ------- -- --�_ , DATE ,_� --.-�,..Y .. BUILDING PERMIT ISSU'ED-----------------------------,� '+-° � .� '• - --------------------------------- Alterations--.and/or recommen ations:"_."-""---------- --- .-------•.--------------------- ------------------------------------------------- -------------------------------------------------------- -------------- -------------- ---------------------------------------"--------------------------- -------- •--- -----•------------- ----- - ----------------- - ---------------------------------- Date------ ---------y '_20 FINAL INSPECTION BY:------------- +- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 300 West Oak Street Tracy, California 130 South American Street Lodi, California Manteca, California .0 Stockton, California ES-9-2M 10-52 Revised W-2100