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APPLICATION FOR SANITATION PERMIT Permit No. ._1--G --•1-•------ , (Complete in Duplicate) Da}e issued .- -'-- /--�- nd install the work herein described. Application is hereby made to pP Joaquin Local Health District for a permit to construct atSan with County Ordinance No. 549. J This application Is made in compliance w .. --- --- .-- '';-- JOB ADDRESS AND LOCATION...___o/__07.- V -- ------ Phone--------------------- ----- --- ------------------------------ Owner s Name------------- p \ I. ! -�"; -------------------------- Address \ -----------'---- -- -------•----- „ Phone----------------------------------- Contractor's Installation will serve: Residence. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ------ Number of bedrooms .3. -- Number of baths _ ..._ Lot size . ------ ------ z -- - - Private Depth to Water Table :��__ ft. Water Supply: Public system ❑ Community system ❑ l ® y ClayAdobe❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand] Gravel ❑ Sandy Loam Clay Loam [I Yes ❑ No ❑ Previous Application Made:. Yes ] No ❑ New Construction: Yes j] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or'cesspool permitted if pub is sewer is available within 2 n feet.) istance from nearest well 0 .__._.Distance from foundation.._ _a..-........Material.. - I Septic Tank: D ._Ca acit af_�------------- No. of"compartments.--- ---Size-. .3'h, Liquid depth P Y Dis vsal Field: Distance from nearest wei Q _.___....Distance from foundation. a_ -...:_...Distance to nearest lot line_--+ ...._..__ p / Number of lines---___-�- -- ------ ength of each line----- ------- -----.Width of trench-_ .- Type of filter material-- -- - Depth of filter material__." ...__..-...Total length__+ -. -------------------------------•-- Seepage Pit: Distance to nearest well......................Distance from foundation___.....___...._._.Distance to nearest lot line...__._.._..._... Number of pits e - l - - Lining material-----------------------Size: Diameter-----------------------.Depth--------------------------------- Cesspool: Distance from nearest well .............Distance from foundation------ i Haid Ca eacit g � ❑ Size: Diameter-- ------•---------------------- ---Depth-------------- ---------------- ------ - ------ q P y---------------------�---- Privy: Distance from nearest well--------------------------------- - -------------Distance from nearest bulldlng------------------------------------------ ❑ - --------------- Distance to nearest lot ine_____------------------------------------------------------------- ------- ------ --------- ----- --------------------- ( Remodeling and/or repairing (describe)--------------------------------- --••----•---------- -------------------------------------------------------------- {� ------------------------------- ---------•----------- ------------------------------------ certify fate that I hales preparedand this ns application the San ,laaquinhLocalkHealltheDistrEcfin accordance with San Joaquin County 1 hereby and ordinances, ___-.___(Owner and/or Contractor) (Signed) ------------------------------------- --------------------------------------------------- -(Title). $Y ---------- --- - (Plot plan. showing size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse s� e. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------------------------------- DATE-- - REVIEWED BY------------------------------------ ------------------------------------------ -------- ------------------- - -------------- DATE------------------------------------------------------------ BUILDING PERMITISSUED-----------------------------------------r .1$° --------------•,------ - D TE Alt m .. Alterations and/or recomendation ...... -- � 0 Ak ----- --------- -r-------- + / � _ _. ------ ---------------------------------•-------------------------------- ----------- -- ------------- --------------------------------------------- ----------------- - -- - ------- r �� t - ---------------------------- •. Date------- -------------------- -•------ ---------------------------------------- FINAL INSPECTION BY: _-_..._ -_-- SAN JOAQ.UIN LOCAL HEALTH DISTRICT 300 Wast Oak Street 132 Sycamore Street 814 North "C' Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y� ES-9-2M Revises 1.57 FY-CO.