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�\ � .Permit No. -.•Z�.�`-.-�':.-• APPLICATION FOR SANITATION PERMIT - 3/. 5 (Complete in Duplicate) Date Issued _g.................. AD 1 Applica+ion 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 Or finance No. 549. ' -------------------------------------------------------------- JOB ADDRESS AND LOCATION........pl..-- -` ....----• . ` '-•--- - - -------------------------------------------- Phone.----------------------••--•-------- Owners Name------------------------•-- - ---- - ----------------------------------- .. Address............ ----- ---------•----- Phone Contractor's Name--------- ._. Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑v /--- Number of bedrooms ------ Number aths ` Lot size ....... Number of living units: _! Public system Community system ❑ Private Depth to Water Table -- ft. Water Supply: Pub i y ❑ .Adobe HardP an ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑Gravel ❑ Sandy Loam ❑ Clay Loam Clay❑ Previous Application Made: Yes ❑ No "New Construction: Yes Ivo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p blit sewer is available within 200 feet.) p / �s , Distance from nearest well_ -_.--__Distance rom foundation_.._ Septic TCapacity -_ --- __:_-..-_-- No. of compartments---g------------------ Size_J- -Ligwd deP,h Z--------- __Distance to nearest Disposal Id: Distance from nearest well _.__Distance from foundation..® Width of trench.._.._�tS. ---- ------•------- Number of lines_-_-___/--_-.I-- ength of each line... ----- s� Type of filter material_/i- - *.- epth of filter material- �___*_.Total length___._...:c��------- /34_.__.Dist Ve to nearest lot line...�0 --.• found ion.__.__..__ Seepage t: Distance to nearest well � � -Distance froe: Diameter.. --•- ----Deptn--R?o • � Number of pits.----- Lining material_ . - - H- ----I 1 Cesspool: Distance from nearest well - _-_---_.._Distance from foundation---...............Lining material----------------- als. Depth------ --------------------- Liquid Capacity g ❑ Size: Diameter--- - T,' w arest ell Distance from nearest building______ Privy: Distance from ne ❑ Distance to nearest lot line----------------- ------ Remodeling and/or repairing (describe):- .......I'll ............i;;;;,V0L t •--•-------- - -1 ••--------•-•--•- ------------•-------••-.--•••- -------------------------------------- ----- . I hereby certify that.I have prepared this application and that the work will be done in accordance with San Joaquinoun -, ordinances, State laws, and rules and regulations of the San Joa in Local Health District. - .�------------- ----- ----( Contractor) ol Si nedA --- ( �9 ) ..t; Tale By:.............................. (Title) - (Plot plan, showing size o t, location of system in relation to wells, buildings, etc., can be placed on reverse si DEPARTMENT U FOR USE ONLY _. ' DATE_ APPLICATION ACCEPTED BY- -- ----------- - - --- Ire REVIEWED BY = w a - --------------------------- ----- DATE_..�::� ---- BUILDING PERMIT ISSUED.__. ._._ ,,�- ------------------------------------------------------------------------------ - DATE ------------------------------------•- Alterations and/or recomm ations:..------------ -------------------------------------------- ----•----•-•----••-----•--•-•---- -- ......--•-----••---------------------- - 1 6 ------ �---------- -- ----�,. - ------- ---------- ----` ✓" -• .. ......................................................... `� -- .................. ...........---- -------- ------ ----------------------- ---------- Date ---- --------------•-- FINAt'CNdSPECTION BY------- - ---- ---- ----- -------- -------------------- Date_._. -- -•----•---.--- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street ` 130 South American Street 300 West Oak Street Y Trac California Stockton, California Lodi, California Manteca, California Y' y -54 ES 2M •.14544r ATWI]OC 12 f •+� L'