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� 4 APPLICATION FOR SANITATION PERMIT Permit No, %± / (Complete in Duplicate) Date Issued --- /)/ ,7/ - Application 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 County Ordinance No. 549. JOB ADDRESS ANDL CATION Owner's Name_ 6 - -------------------•- ----•--------- - - -��'. ._ `--- ------------------- ------------- -------- - ------------ -------------- --- Address-------= -- -------------- ------ ------- -- ---- Phone ---- --------- --- --------- - •--•----------- -------------- - -----•---•---- ----/-------------- Contractor's Name_________________________ Installation will serve: Residence Phone �f __ E`C ©Apartment House ❑ Commercial ❑ Trailer Court Number of living units: Number of bedrooms - -- Number of baths -_/-__ Lot size Motel ❑ Other ❑ Water Supply: Public system �C_____�-'r-�-�- � PP Y= Y Community system ❑ Private ❑ Depth to Water Table �_� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam Previous Application Made: Yes ElNo Y E] Clay El Adobe�'"�iardpan E]©�New Construction: Yes ❑ No 2`16HA/VA: Yes ❑ No [ear TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) Septic Tank: Distance from nearest well. f � ---------Distance from foundation---��-.. ��-�__ No. of compartments_-.--- --- -----Size-S 3�`' t ------ -- ------ Disposal ----- y -- --Liquid depth-- '5"./�--- Capacfty_r _� ------ j disposalField: Distance from nearest well ° �lDistance from foundation__. __G' L"S Number of fines___________ - ---Distance to nearest lot line_.,/G_-_`__ --------- - -- -- Length of each fine------- c'• --- Type of filter material__:6�__.R -Depth of filter material._-- ------Width of french__. _--------------------- Seepage ./ � ------------------ See a e Pit: 1-,---------Totai length__---- � p g Distance to nearest well-',Z�ltXi ^� - .___Distance�r om f undation___ C __ Distance to nearest lot Iine___ �-__._ Lam' Number of pits. ---- _-- Linin material_ Lining { __,.Size: Diameter__.,3 j '--- -- Cesspool: Distance from nearest well_-._. __ Depth__-- -_' Distance from foundation_ ____________Lining _-_ ❑ Size: Diameter -- - --� -- --- -- -----Depth----- - ---- _ _ .---------•----------- - - --- Liquid Capacity.._--•---------- - Privy: Distance from nearest well-------------------_-- - -- ------_gals. ---------------Distance from nearest building--_------------------- (� ❑ Distance to nearest lot line_-_____-------- __ -- ------- -- - - ----------------------------- Remo e ing and/or repairing (describe)--- ----------- ___________________________ ________________________________________________________________________________._______-._ l' _ r hereby certify that I have prepared this application and that the work will be done in accordance with San -- -• -------- ordinances,-$tate laws, and rules and regulations of the San Joaquin Local Health District. Joaq --n County -----------------------------�Y -- --(Owner and/or Contractor) BY: -------------•---------------•-------- L -_ "- r �J - -- �- L��-;i�.-�.:_;�iE--�----------------- -- Title_-`� ___ --(Plot plan, showing size of lot, location of system in relation fq/wells, buildings, etc., can be placedrever 1/ se side). FOR DEPARTMENT LISE ONLY APPLICATION ACCEPTED BY.. REVIEWED BY --- --- - ------------------------ ---------------------------I DATE---- ------------------------- DING PERMIT ISSUED__ - - -- -------------------------------------------- _ ATE- --- ------ ------ Alterations and/or recommendations:-_------- ------ ----------------------------------------- ----------------- ------- DATE ----- ---------------------------- ----------- --------- ------ - - ------ ----------------------- ---------a----------------- - --------- ------- ------------------------- ----------- ------------- --- - -------------- FINAL INSPECTION BY:._-:------s-: ------------ a e--- ------------ ----i ---- 130 South American Street SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wes+ Oak Street 132 sycamore Street Stockton, California Lodi, California 814 Nor+h "C" street Manteca, California Tracy, California ES-4-2M , Revisep 1-57 F.P CO.