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APPLICATION FOR � � v� SANITATION PERMIT N6 ._ . ` (Complete in Duplicate) Date issued Application is hereby made to the San Joaquin Local Health District fora permit to construct`and install the work herein described This application is'made in compliance with County Ordinance No. R JOB ADDRESS AND LOC TION----.. - -------- -------------------------------- ---------- - ---- ------- --- ---- ------------- --- Owner's Name 1 - ---- Phone . . V / - -- --_---_ Address ------- - c _!ji ......4 ------------ ,6-. t. -�- - Contractor's Nome--------- Phone Installation will serve: .Residence Apartment House Commercial,❑ 'Trailer Court ❑ Motes( �,Other ❑ Number of living units: __l____ Number'of bedrooms ____ N-umber of baths _I_„ Lot'size _._ _ _ __.___ 1!1 _ _- - a Water Supply: Public system ❑ Community ,system ❑ Privates Oj, -Depth to Water Table ' ft. Character of-.soil to a,dep+h oT 3 feet: Sand ❑ Gravel ❑ Sandy Loam (X Clay Loam ❑ Clay❑" Adobe❑ Hardpan [ Previous Application Made. Yes Q No (5d New Construction: Yes No [] TYPE OF INSTALLATION AND SPECIFICATIONS: (fiSeptic tank or cesspool permitted if.publj�c sewar is available within 200 feet.) Septic ank: Distance from nearest well Distance froym fq y ron__.� i _._'Material _,?Q l r� No. of compartments__-_____ ,,.__-- Size - f t�-- -----------Li ud depth Ca Gott q p "# Dispos field: Distane8 from nearest .well -Distance from foundation ,�►� Di a to nearest lot Number of lines:._-_ _- ---._Length of each IEn ��e� Type of filter material. v- —___-__-Depth of filter material. ,e :� ,.._To#al Isngth__ Seepage-Pit: Distance to nearest well-.--------------------Distance from foundation__--__________.:.Distance to nearest lot line____w,-, _____ ❑ Number of pits- _- _------Lining material-----------------------Size: Diameter----- ---------------.Depth--------- ------ -- -- Cesspool: Distance from nearest well.................Distance from foundation---------------------L-ming•Material_ _______ __-______ ` 171Size. Diameter____ -----------Depth----------------- _Ligvd CalsaCity gals; Privy: Distance from nearest well--------------------------------------------------Distance from nearest buildingFj ____.. Distance to nearest lot line ------------------ ------------------ -_--- - ------ k Remodeling and/or repairing (de'scribe):-------------------- - ': :_._. .. ------ ------ -----•--- ------- ------- ---------- ---- -----•--- -------- ------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- c 71 ------------------------------------------------------------- -- ----------------------------------------------------------...----- ------- --------------------------------------------.................... -1 ---- ------ -1 hereby an`certify that I have prepared this application and that the work will be done in accordance with SJoaquin County; ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed]----- ------------------ = - -------------- --------•-- -------(Owner and/or Contractor3 � _ � lila) - _- --------------- . _ Plot n,th6w ( plan asg.std of I+at�lct�afion of system,In relations was, �utrrgs, ter#" FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY "_ -- - -- DATE REVIEWED BY -------- -- -_ __- DATE -- ----- ----- - BUILDING PERMIT ISSUED----- ---------------------- --------- -------------------------------- ------------- DATE: „ --- Alterations'and/or recommendations: -- ----------------------------------------- ------------------- FtNAL INSPECTION BY: - Date ----------------------- -------- 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 iv