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APPLICATION FOR SANITATION PERMIT Permit No. y, A (Complete in DuplicateJ _ Date Issued J -� Application is hereby made to the SaniJoaquin Local Health District fora r This application is made in compliance'wifh County Ordinance No. 549 permit fo construct and install the work herein described. JOB ADDRESS AND LOCA ION - Owner's Name_ � - hn-- -- •-- _ a� � --- Address_•__..___ --------------------------- __. oe ' a .__ ---- -------� Contractor's Name:l----- lM ` -------------------------------------- -- ----------- Installation will serve: Residence} Pho e_.____ ❑ Apartment Nouse❑ Commercial E] Trailer Court ❑ Motel Nurnber of living units: __: Number of bedrooms - ❑ Other . !�i ___-:'__ Number of bafhs -------- Lot size.. _ Water Supply: Public system'❑ Commun'i system ------ tY y ❑ ''Private Depfh to Water Table x - Character of soil to a depth of 3 fee+: +Sand E] Gravel ❑ Sandy Loam [Clay Loam E] Cla Previous Application Made: Yes ❑ No N ' F Y El Adobe (] Hardpan ❑ ew Construction: Yes KNo 0 FHA/VA: Yes ❑ No [] TYPE OF INSTALLATION AND SPECIFICATIONS: + I - :.r(No�sep#ie,+anis•orcesspool-permitted°if public=sewer is.available witftin 200 feet. t -, _r 4.4 .o-..�. _ - �1 Septic Tank: Distance from nearesf well_e,V-��_Distance from fou dafion_�'9Maferiaf-__ !" -L� . No. of compartments--_ ----- -- = ---------- Size_ - i • k Li uid de th t Ca 2a s ,. 5g ,: X g 1? pacity-----------•----- well-1..20_--._Distance from foundation--f-Q--- / Field: Distance from nearest y 2 ® Number of lines------ 1 a, �.;aDistance to nearest lot line_ - Length of each line--- J______________ Wldfh'Of trench---.2_ .._._------- -_-- Type� of filter material-'�r ----- t ' Depth of filter material_:../'�� ---- Totaf lerl th__,____.__ Seepage Pit: Distance to nearest weif___"."__---_____ Distance from foundation ---___ g `� O ❑ Number of pits-_-_ t Lining material______________ D+stance to nearest lot line___--:_____-_____ ___Size: Diameter------------------- Depth Cesspool: Distance from nearest wel---------------_Distance from foundation.____---_--s ❑ Sizer Diameter------------------------------------ Lining material------------ eptly '------------------------------ = " Liquid CaPac'fY-----------------------Disfance'from nearest well _---'- gals. _Distance from nearest building__________________________ ❑ Distance to nearest lot line__------- • � g ----------------------- --------'-------- -- -- _'#-- v - --- ---------�= -----•---'-- ------------ � --- - 1-I - -(descbW®- --- le--- - - ----- ------1 � - ------------- ------------------------------------------ •_ . pp = --- ----- ---,.--•------------------------------- I hereby certify that I have re ared this-a licafion and that the work will be done m=accordance with San Joaquin ordinances, la s, and rules and regufafi_ons of the San Joaquin Local Hee[+h DiOric+.' ^ qum County (Signed).. /1J Plot Ts _ .Ix ----------- ----------------------------------------------- r c ( p , w er an on a � (O n d/or C + for Ian, showin size of lot, locafion`Of s "stem in.r Title) ------------------------------------------------ Y elation to wells," --- -- ----- buiWings, efc.; can be placed on-reverse side). FOR RTME T USE Q, LY APPLICATION ACCEPTED REVIEWED BY ------ a "P -- -- DATE-R BUILDING PERMIT ISSUED------------------------------- -_ ------------------ - DATE---- -------------------- - Iteraf'ons anor recommendations:___ _. DATE- ------------------------- -- -------------------------------------------- ---- ------. _ FINAL INSPECTION BY----- - ---- t - 3 Date__. =• --. ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street 1odi, California Manteca, California � Tracy, California 15-9-2M Revisea 1.57 F,P.CO.