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ATION FOP, 'SANITATION PERMIT Permit Info. (Complete in Duplicate) Date Issued 4 _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe. This application is made in compliance with County Ordinance No. 549: ---•--JOB ADDRESS AND LO O _ . ____. _ -._.. Owner's Name.--- ---- ------- -- Phone.................................... ��Z�! Address................ X ..._, --- ----- --- .......................... Contractor's Name...._ _ _LI. ....... ... one.,_ ... V ----- --�..-- - --- .�� . . h Installation will serve: ' Residence Apartment House❑ Commercial ❑ Trailer Court ❑ to Other ❑ Number of living units: I-___ Number of bedrooms _Z Number of hs /---_ Lot size ....... ............. Water Supply: Public system ❑ ,Community system. ❑ Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loamay Loam ❑ Clay-0 Adobe[] Hardpan❑ Previous Application Made: Yes C No 5KNew Construction: Yes,, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tant or cesspool permitted if public sewer is:available.within 200 feet.) Septic TSpke Distance from nearest well Distance fr foundation -_��___:Mat ri'I No. of.com artments--------------------------Size--- --m- _ p ..,!/ _/_� `"'Liquid depth- --; - ---Capacity''„ _.. ,r Disposal F' Distanca-4rom nearest well i ._. istance from foundation-_,f..d __.Distance to nearest tine Number of lines------�` Length of each line___ �, Width of trench Type of filter material_ Depth of filter material ./r______-._Total length------ ...... Seepage Pit; Distance to nearest well..-.-----_______.._Distance from foundation..................Distance to nearest lot line.......,•.... ❑- Number of pits---------------------.Lining material---------------------Size: Diameter------------------------Depth......... _,...... ,......+_. k Cesspool: Distance from nearest well________________Distance from foundatyon.....,-----------,.•Lining Size: Diameter... - Depth "` ❑ -------- ..._..- •. Liquid Capacity Privy: Distance from nearest well.______ _________ _____-------------Distance from nearest building ❑ Distance to nearest lot line-............................. � Remodeling and/or repairing (describe):--.............` . _ �L' " - ---- .......... ....... ........ _ A ........ ...................... .............1w1..................... _. ......._. ------------------------------------------------------ --- -----uw•.... _.....+ten.. •----- • I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counj ordinances, State I ws, d ru 's a ` re Mations of t San Joaquin Local ealth District. " (Signed) - � - --- -------- -- ------- - - era or Con By:------------- -' - ----------------------------------------- ------- ....:(Title) --- ----- (Plot plan, showing size of lot, location of system in relation to ells,'buildings, etc., can be placed on reverse aide), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ` � /�` REVIEWED BY --...................................... K DATE BUILDING PERMIT ISSUED:: ---.------------------------....................................... ---- DATE ------ ------------------ Alterations and/or recommendations:.. ..-- ------- ------- - ......................................... --------------------------- --- -----------------------------•--------------------- ---------- -------- ------- ------- ---------------------------- ------- - =-- ------ ... ............... FINAL INSPECTION BY: ;.� Date------ -- --- SAN -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