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APPLICATION FOI SANITATION PERMIT -__- \` (Complete in Duplicate) u Date Issued 1' Application is hereby made to the San Jeaquin Local Health District for a permit to construct and install the work herein describ r This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L CATION------..tvw_.4��------'t pf.------44/7W;-0-5----•-------- 1 !--------------------------- ----- --- - L .•�- / A c Phone__ Owner's Name / 1--t - Address t- •-- •••-- Phone ---_---Contractor's Name Q + �.` , Installation will serve: Residence ❑ Apartment House ❑ Commercial' ❑ Trailer Court- ❑ Motel Eff Other ❑ Number of living units:__&--- Number of bedrooms _�7___ Number of baths _' Lot size -•- -.X_, -� . Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table#4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam-E] Clay Loam ❑ Clay ❑ Adobe Hardpan Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AWSPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) c Tank: Distance from nearesteh` Q11/ -Distance from foundation_ Q------------ Septic Mat fial .� . No. of com artments__' - Siz q p -________Capacity IQ(� p � ___-- _-- es__e�a'-�fD_:-�"je_---Liquid de th,��------ a Disposal Field: Distance from nearest well j*1P1 E Distance from foundation 4 Distance to nearest lot � Number of lines.f�/ , __ _ _____Length of each line____,�� Width of trench , Type of filter material Depth of filter material___._ ___'�____._.Tatar length_:____ _________ . Seepage Pit: Distance fo nearest well__,# /*0istance from foundation---Z40_�......Distanc a to nearest 1 t line_ Number of pits__QWiE-_______Lining material.-BA] Diamefer_�co __ Cesspool: Distance from nearest well.................Distance from foundation----_----_--------Lining material._ __-------- _____-Size: Diameter_-- ------- Depth --- _ ' id n . Privy: Distance from nearest'welG_____. ___ ____________bistance from nearest ilding______ __-__.__._.._-__.-- Distance to nearest lot line---------- ____:__ ------------ Remode g and/or epailkAg (descri _ 1 ------_. -------- �� w .�I� - __________________________________ ~_ /�� _ - ---------------------- ....._ ... ...... ....... ............'.. A� .1/,1�� - --- �2 *s-,r--7%0.41S------- ----- - --. 3 hereby certify that I have pr ed this application and that the work will be done in accordance with San Joaquin_+} ordinances, ws, and r7 TA ules nd egulations of the San aqu' ocal Health istrict. tela (Signed) ------ -•--/ - ----------i _�=/-.�_)_�- , - ---------------- ------ 1------ -----'--(Owned and/or Contra Title f (Plot plan,.showing size of lot, location of system in elation to wells, buildings, etc., can be pla d on reverse side FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ------ -- - -- ---- DATE -i .« REVIEWED 8Y - - DATE "" ----- BUILDING PERMIT ISSUED-------------------------------- -------------- ----- t--------------------------------------------- ----• DATE- ----------------------------------------- Alterations and/or ----- --- ----Alterations=and/or recommendations:-------------- _________ __________ _ __ - FINAL INSPECTION BY:----------- -"Y ------- Date-----V __`4r __- 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-9-2M 8-51 Revised W-2100 r f ,.