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r-, APPLICATION FOR SANITATION PER r ermit No. (Complete in Duplicate) Date Issued .... Ih Ap icatio is hereby made to the.San Joaquin Local Health istrict for permit to con eruct and install the work herein described. This application is made in compliance with County'Ordinara No. 549 JOB ADDRESS AND OCATION.. ...... ---�' .. -••--- -- - ---- ---- ---- ------- ---- •- f : Owner's Name _ - --- -------- -- -- - - -- ---- --- ---- ---•---- Phone.? Address- _ ,rG -_ - -- - 2 Contractor's Name-------------- •-- - -------------------------------------------------------------------------- --. Phone------ Installation -Installation will.serve: Residence' AparfLnpnt House ❑ Commercial ❑ Trail //ec Court ❑ Motel [� Other F1Number of living units: .:_-__ Number'of bedrooms >-Z- Number of baths t-_° Lot size __ lam Water Supply: Public system ❑ Community system [( Depth to Water Table.__5ft. : Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe,, Hard' nor p ❑ ❑ y ❑ ` Y ❑ ' Y ❑ P+s Previous Application Made: Yes ❑ N New-Copstruction: Yes ❑ No, e, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 foot.) � Septic Tank: Distance-from nearest well�j, 1�r1 Dis#ance from f9un atippn_ Materi I No. of compartments____o�-------------Size__,__,, y liquid' apth, _ . _____Capacity...... Disposal Field: Distance from nearest well-------------------Distance from foundation_.___ ._.._______-Distance to nea" . 'lot It ❑ Number-AT lines___________ ___ __•.:-______..Length of each line-----------_..................Width of trench Type of filter material.____ ______________Depth of filt terial:_ _: Total length _-__; ____t_ Seepage Pit: Distance to nearest well /�____.Di r e on1 f I ionl. Distance to nea' t lot lin, { Number of pits-------- ____-______Lining m rial e: iame#er.__�............ _.Depth- io h_ . -------- Cesspool: ____-„A y Cesspool: Distance from nearest A*I ..........___ istance f nd jon ---------------Lining material............ ------------, Size: Diameter --- ------------- ------•.Dep -_- - - ----- ---_Liquid Capaci#y` - . Privy: d . Dis#ante from nearest well__ ___________ _____ ___________________ Distance from nearest building , tante to nearest lot Fine-_---___, ❑ - - - Remodeling andj #apairing (describe)•-- - ..............................----------------- -------------------- --------------------- ------------------------ ------------- -------- -- --, - -- -- - - - ------- - hereby certify 4iat Vhave•prepared this application and that the work will be done m'accordance wit tb, an Joaquin ordinances, Ste ws, and ule nd regulations of the San Joaquin Local Health pistriot. ----- -” ------------------------------ (Signed) - (Owner and/or Co £ y B - ! - (Title) -r ------- r (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be 0iaced on reverse side). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - - -------------------------------- --------- ------------------ DATE, REVIEWED BY. ---__ --- -- -------- _ DATE-- BUILDINGPERMI `ISSUED-------------------------- -- ----------- -- - -- ------- --- ---- ----,_. DATE-------- ---- Alterations and/or'recommendations --- ----- - ----- -- - _.._ - ____________ _____________ ________ _ _________ - .•- 4 - -- ----------------- _ - FINAL INSPECTION BY: /--------------- Date------ : .--''r ' . ter , 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