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Permit No. APPLICATION FOR SANITATION PERMIT r (Complete in Dupl atelEXPIRES ONS YEAR Date issued _y�5------ 1 FROM DATA the work herein described. Application is hereby made to the San Joaquin Local Health District fo pp p with County Ordinance No. 549. This application 1s made in compliance w JOB ADDRESS AND LOCATION ----- ___!f__/---------- -------- -- - -- - --- - - ---- - _------------ =-'---- Phone Owners Name - -•-------- Address - I ! l - --one---------------------------- --- --------------- -- Contractor's Name -------- - - - --•---.�~--••- - - -- -- - - - '- ------------------------------------\._ Ph Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.,'L��4 -----•-----------------"-------------= Number of living units-- Number of bedrooms�INumber �of baths Lot size ------------------------------------------ Water Supply: Public system 131.�,Commursity system ❑ Pr4vate ❑ Depth to Water Table: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ &ndy Loam Clay Loam ❑ Clay F] Adobe I-]HardpanE]I } Previous Application Made: Yes ElNo'� New Construction: 'YesX No PHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:, (No septic tank or' cesspool permitted if public sewer is. available within 200 feet.)�/' �y7___----- Materiai--- p fiance from foun eLilcluid ____ _ de th------Ix ---------------Capacity-/49P1 _ --- Septic Tank: �. -u Distance from nearesr well__ _______Dist No. of compartments_ p ' # Disposal Field. :" Distance from nearest well.-.ka Distance frorri foundation_-__ Distance to nearest lot If� '_ y"� -____ Length` of each line---=-- - ---------.Width of trench -- from --- �.umber of lines Total length--- --j en th Type off filter materi I-_ - -----Depth of filter material_---______-- g C' x " - � _. Distance to nearest to ne_-'Y-6 Seeps a Pit: Distance to nearest welL__�� _-- ��stan e fro founds ion_=-;,�..___ - J Llning material__ Di meter_--x.[-Depth------- Number of pits-----/-- -- F j� '------------------ ---- Cesspool: Distance from nearest well__________________Di n e ram o dation____-_____________.Lining material______-.-__-_ I[t ❑ ,„Size: Diameter ' wr '� = r �De�th. ; -------------------- ------------------Liquid Capacity ---------------------------- gals, � t. , g ---------------------------------------- i privy: DistaA�;e from nearest well -------------- A --_____________`__--------------Distance from nea�est buildin ❑ Distance to nearest lot line :' -------------- -------------------------- -- � a„z �' � lei Re adeli and/orepairing-( scribej:____---� laJ" ____ _. _ _ b ------------------- _ ° ---------- ------- A�'� _. ------------------------ - ----- - --- - ----- f -----------=--------------------------------------------- - ----------•------- ------------------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. r (Signed) -------------------------------------------- ----= {Owner and/or Contractor) y:.- - - ---------- -------------------------------------------------(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 I APPLICATION ACCEPTED BY------- --- --- - DATE __ REVIEWED BY----------------------------------- - ------------~'------- DATE_ •1 � -------=------- DATE------ ----------- ------------ --- -- ----- - BUILDINGPERMIT ISSUED----------------- --------- -- ��---------- - --------- ---------- ---- - - Alterations an�or recom endations::_-_______�.__-___--------- ------ --- -------- �{ -- ----- _ - ------ ----------------- --------------------------------•--- =-s = ------------------------------------------ -------------------- -----A --------- l'Z��-..----------------------------- ---- FINAL INSPECTION BY:----- -....date-------..1�---- SAN.JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -4-2M Ravisep 7.57 F.P,CO.