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V AP PLICATION FOR SANITATION PERMIT Permit No. ._ .a- (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for Date Issued This application is mLeinompliance with County r 'Hance No. 549, a to cont ct a � i e ` l a or erei eseribed. JOB ADDRESS ANA_LN----�11 . Owner's Name_._:'" _ Address_.--- n � �_._ td,t . a "s... Contractor's Name.______ - # Installation will serve: Residence ----- � x = Phone,?, ❑ Apartment House ""'----'�:r� -� ❑ C mmerc�' I ❑ Trailer Court ❑ Motel Number of living units: -------- Number of bedrooms _ "�' ❑ Other ❑ umber of baths _.------ Lot size _Q_.. x,41 � Water Supply; Public system ommunit system •-• ....Y Y ❑ Private ❑ Depth to Water Table ._._.___ ft. Character of soil to a depth of 3 feet: Sand ElGravel ElSandy Loam E] Clay Loam E3Clay ❑ Adobe❑ Hardpan (] Previous Application Made: Yes TYPE NSTALLATIO ❑ NO ❑ New Construction: Yes El No ❑ FHA/VA: Yes ❑ ❑ N AND SPECIFICATIONS: No No septic tank or'cesspool permitted if public sewer i e ti T s available within 200 feet.) Distance from nearest well-----------------Distance from foundation_.__:_ No. of compartments------ Size Material •----- ---Liquid depth..... -------------------------------------- Distance from neare t well--tA!--rW -.Distance from foundation___. _ -- -`----Capacity..___ _ - ° Number of lines-.._._/.- __.Distance to nearest lot line._,Q- Length of each line____ _'} Type of filter material s " --- -- __Depth of filter material_____- f Width of french. � gip- •--- Seepage Pit: Distance to nearest well_____ _:,____ ---Total length.._--JGZ_.R _{ ___ _.__Distance from foundation_._..._: ❑ Number of Pits____.________._____Lining material_-____ Distance to nearest lot line___:-_-_.__. Size: Diameter---------------- --- ----- Cess ool: - _ Depth-------------------------- p Distance from nearest well-----------------Distance from foundation____-________..___.Lining material---------------------------------- -------- _.__ Size: Diameter-------------------------------------- -Depth.------------ _ --- Priv - •-------•--------- --•- ____..Liquid Capacity.- Privy:Y: Distance from nearest well _ -_ __ _- Y ..........................gals. - ------------------------Distance from nearest building❑ Distance to nearest lot line_____..__-•---_ Remodeling an •------ d/or repairing (describe): ----------------------- ------_--- --------- --------------------------------------- ... -•--- ------------------------------ hertbofy that I have re are ---- ----------------•------------------- ordinance p p apphcati, and that fhe work will be done in accordance with San Joaquin County awsand les and re frons of fhe n Joaquin Local Health District. (Signed)..- BY: -•-- -•----••------•-------••-••--- -- &14,1 t Contractor (Plot plan, showing size of lot, location of system in relation to a �� (Title).__ l- ' uildings, et can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY' 4'� REVIEWED BY--------•-- -------- ------------------.-.----- DATE„ '_._ BUILDING PERMIT ISSUED----"--- DATE_-k----._..--•-----------------•---------•�----------- flo Alterations and/or recomme - -- ---- .. ------------------ 2 ---------- ---------------•----•-----el ..................................... /m .?--- 'Ole-fe jt ................................................--•------- - - c7az FINAL INSPECTION BY:._ l / ------ Date..../01 `�`-1 { 130 South American Street SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "C" Lodi, California Manteca,.California Street ES-9-2M , Tracy, California Revised 1.57 F.P,CO.